Healthcare Provider Details

I. General information

NPI: 1780500751
Provider Name (Legal Business Name): MEDORA LIFE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 BERKLEY KNOLL CIR APT 10102
RICHMOND TX
77407-3347
US

IV. Provider business mailing address

5600 BERKLEY KNOLL CIR APT 10102
RICHMOND TX
77407-3347
US

V. Phone/Fax

Practice location:
  • Phone: 432-243-4243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SYED ANAS
Title or Position: OWNER
Credential:
Phone: 432-243-4243