Healthcare Provider Details

I. General information

NPI: 1801823984
Provider Name (Legal Business Name): BENBROOK NURSING & REHABILITATION CENTER, L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MCKINLEY STREET
BENBROOK TX
76126
US

IV. Provider business mailing address

200 DRYDEN RD E STE 2000
DRESHER PA
19025
US

V. Phone/Fax

Practice location:
  • Phone: 817-249-0020
  • Fax: 817-249-6514
Mailing address:
  • Phone: 215-441-7700
  • Fax: 215-441-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number116637
License Number StateTX

VIII. Authorized Official

Name: MR. PETER J LICARI
Title or Position: PRESIDENT OF GENERLA PARTNER
Credential:
Phone: 215-441-7700