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NPI Code Detail

MEDICARE: CLARKSVILLE NURSING CENTER, L.P.

MEDICARE: CLARKSVILLE NURSING CENTER, L.P.
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
1332BN1400XNursing Facility Supplies (DME)114514TX
2332BP3500XParenteral & Enteral Nutrition Supplies (DME)114514TX
3314000000XSkilled Nursing Facility108380TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992793038
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLARKSVILLE NURSING CENTER, L.P.
Provider Business Mailing Address
First Line : 200 DRYDEN RD E
Second Line : SUITE 2000
City : DRESHER
State : PA
Zip : 19025
Country : US
Telephone Number : 215-441-7700
Fax Number : 215-441-4255
Provider Business Practice Location Address
First Line : 300 E BAKER ST
Second Line :
City : CLARKSVILLE
State : TX
Zip : 75426-5034
Country : US
Telephone Number : 903-427-2236
Fax Number : 903-427-5235
Authorized Official
Title or Position : PRESIDENT OF GENERAL PARTNER
Name : MR. PETER J LICARI
Credential :
Telephone Number : 215-441-7700
Provider Enumeration Date : 10/12/2005
Last Update Date : 10/26/2007

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