Provider Demographics
NPI:1902140171
Name:DALLAS HEALTH CARE CENTER L L C
Entity Type:Organization
Organization Name:DALLAS HEALTH CARE CENTER L L C
Other - Org Name:DALLAS RETIREMENT VILLAGE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAVERKOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-391-7549
Mailing Address - Street 1:377 NW JASPER ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1279
Mailing Address - Country:US
Mailing Address - Phone:503-623-5581
Mailing Address - Fax:503-623-2901
Practice Address - Street 1:377 NW JASPER ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1279
Practice Address - Country:US
Practice Address - Phone:503-623-5581
Practice Address - Fax:503-623-2901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DALLAS MENNONITE RETIREMENT COMMUNITY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-12
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500653791Medicaid
OR500653791Medicaid