MEDICARE: ROYAL MANOR CARE CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1699154278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL MANOR CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	4545 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-4207
Country	:	US
Telephone Number	:	214-791-2863
Fax Number	:	469-914-5434

Provider Business Practice Location Address
First Line	:	4545 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-4207
Country	:	US
Telephone Number	:	214-791-2863
Fax Number	:	469-914-5434

Authorized Official
Title or Position	:	MEMBER
Name	:	REGINALD BENJAMIN
Credential	:
Telephone Number	:	214-791-2863

Provider Enumeration Date	:	05/28/2015
Last Update Date	:	05/28/2015

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