# SUBTENANT 3611 DICKASON AVENUE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689868861
- **Authorized official:** RAYMOND C OBORN (REGIONAL VP OF OPERATIONS)
- **Authorized official phone:** (949) 240-7200

## Contact information

- **Practice address:** 3611 DICKASON AVENUE, DALLAS, TX 75219-4912
- **Practice address phone:** (214) 559-0140
- **Practice address fax:** (214) 559-0171
- **Mailing address:** 3611 DICKASON AVENUE, DALLAS, TX 75219-4912
- **Mailing address phone:** (214) 559-0140
- **Mailing address fax:** (214) 559-0171

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 130513 | TX | Yes |
| 314000000X | Skilled Nursing Facility | — | NULL | — |

## Other

- **Enumeration date:** 08/30/2007
- **Last updated:** 10/10/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001019490 | — | TX |