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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