Diversified Healthcare-Dallas LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

118368 Issued in TX

Legal business name

DIVERSIFIED HEALTHCARE-DALLAS LLC

Doing business as

Brookhaven Nursing & Rehabilitation Center

Practice address

1855 Cheyenne Dr
Carrollton, TX 75010-2201

Phone

(972) 394-7141

Fax

(972) 492-5534

NPI assigned

Mar 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Tom Marks

Title

Administrator

Phone

(972) 394-7141

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brookhaven Nursing & Rehabilitation Center Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313107200000",
    "number": "1093847378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 CHEYENNE DR",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750102201",
            "telephone_number": "972-394-7141",
            "fax_number": "972-492-5534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 CHEYENNE DR",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750102201",
            "telephone_number": "972-394-7141",
            "fax_number": "972-492-5534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSIFIED HEALTHCARE-DALLAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2011-08-12",
        "status": "A",
        "authorized_official_last_name": "MARKS",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "972-394-7141",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "118368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001013833",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookhaven Nursing & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Carrollton, TX
• Providers in Carrollton, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.