1396820890 NPI number — LA DORA MANAGEMENT, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396820890 NPI number — LA DORA MANAGEMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA DORA MANAGEMENT, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LA DORA NURSING & REHAB CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396820890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1960 BEDFORD RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76021-5712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-283-4771
Provider Business Mailing Address Fax Number:
817-283-4020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1960 BEDFORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76021-5722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-283-4771
Provider Business Practice Location Address Fax Number:
817-283-4020
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEPHENS
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
CHRISTOPHER
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
817-283-4771

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  116904 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 165683701 . This is a "MEDICAID TEXAS PROVIDER IDENTIFIER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001004568 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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