Provider Demographics
NPI:1932160769
Name:DUAL D HEALTH CARE OPERATIONS, INC
Entity Type:Organization
Organization Name:DUAL D HEALTH CARE OPERATIONS, INC
Other - Org Name:KEMP CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C F O
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-332-3030
Mailing Address - Street 1:1415 BALLINGER ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-5905
Mailing Address - Country:US
Mailing Address - Phone:817-332-3030
Mailing Address - Fax:817-332-3032
Practice Address - Street 1:1351 S ELM ST
Practice Address - Street 2:
Practice Address - City:KEMP
Practice Address - State:TX
Practice Address - Zip Code:75143-7713
Practice Address - Country:US
Practice Address - Phone:903-498-8073
Practice Address - Fax:903-498-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4924314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001000512Medicaid
TX675802Medicare Oscar/Certification