Basic Information
| Provider Information | |||||||||
| NPI: | 1629466909 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DALLAS COUNTY HOSPITAL DISTRICT | ||||||||
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| OtherOrganizationName: | THE MANOR AT SEAGOVILLE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5201 HARRY HINES BLVD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752357708 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2416 ELIZABETH LN | ||||||||
| Address2: | |||||||||
| City: | SEAGOVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751592702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722872491 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2015 | ||||||||
| LastUpdateDate: | 08/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | UNDERHILL | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2149544114 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 67-5418 | 01 | TX | MEDICARE CCN | OTHER |