Organization
DALLAS COUNTY HOSPITAL DISTRICT
Active
Other names
Mira Vista Court
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK CERISE MD (CEO)
(214) 590-8006
Entity
Organization
Contact information
Practice address
7021 BRYANT IRVIN RD, FORT WORTH, TX 76132-4243
(817) 361-1400
(817) 361-1400
Mailing address
7021 BRYANT IRVIN RD, FORT WORTH, TX 76132-4243
(817) 361-1400
(817) 361-1400
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001026572
—
TX
Enumeration date
01/15/2015
Last updated
03/16/2017
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