Provider Demographics
NPI:1396820890
Name:LA DORA MANAGEMENT, INC.
Entity Type:Organization
Organization Name:LA DORA MANAGEMENT, INC.
Other - Org Name:LA DORA NURSING & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:817-283-4771
Mailing Address - Street 1:1960 BEDFORD RD.
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5712
Mailing Address - Country:US
Mailing Address - Phone:817-283-4771
Mailing Address - Fax:817-283-4020
Practice Address - Street 1:1960 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5722
Practice Address - Country:US
Practice Address - Phone:817-283-4771
Practice Address - Fax:817-283-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116904314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165683701OtherMEDICAID TEXAS PROVIDER IDENTIFIER
TX001004568Medicaid
TX675934Medicare Oscar/Certification