MEDICARE: ADORA 9 OPERATIONS, LLC

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1740710094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADORA 9 OPERATIONS, LLC

Provider Business Mailing Address
First Line	:	5830 GRANITE PKWY STE 700
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-6803
Country	:	US
Telephone Number	:	318-355-5803
Fax Number	:	505-369-0113

Provider Business Practice Location Address
First Line	:	8130 MEADOW ROAD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231
Country	:	US
Telephone Number	:	318-355-5803
Fax Number	:	505-369-0113

Authorized Official
Title or Position	:	MANAGER
Name	:	HORACE WINCHESTER
Credential	:
Telephone Number	:	505-516-0940

Provider Enumeration Date	:	06/19/2017
Last Update Date	:	11/27/2018

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