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Organization
DALLAS COUNTY HOSPITAL DISTRICT
Active
Organization
DALLAS COUNTY HOSPITAL DISTRICT
Active
Other names
Williamsburg Village Healthcare Campus
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK CERISE MD (CEO)
(214) 590-8006
Entity
Organization
Contact information
Practice address
940 YORK DR, DESOTO, TX 75115-2042
(972) 572-6200
(972) 572-9365
Mailing address
1500 WATERS RIDGE DR, SUITE 200, LEWISVILLE, TX 75057-6011
(972) 899-4401
(972) 899-4460
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
112098
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001004882
—
TX
05
—
001026661
—
TX
01
—
164055901
MEDICAID CO B
TX
Enumeration date
09/08/2005
Last updated
06/30/2015
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