Basic Information
| Provider Information | |||||||||
| NPI: | 1790744159 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DALLAS HOME FOR JEWISH AGED | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | GOLDEN ACRES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5100 BELT LINE RD | ||||||||
| Address2: | SUITE 430 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752547559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724907251 | ||||||||
| FaxNumber: | 9723871281 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 CENTERVILLE RD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752282634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143274503 | ||||||||
| FaxNumber: | 2143202683 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ELLENTUCK | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9724907251 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 675081 | TX | X | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 313M00000X | TX | X | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 314000000X | TX | X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.