Healthcare Provider Details

I. General information

NPI: 1518915933
Provider Name (Legal Business Name): PITTSBURG NURSING CENTER, L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 PECAN GROVE
PITTSBURG TX
75686-1899
US

IV. Provider business mailing address

200 DRYDEN ROAD, SUITE 2000
DRESHER PA
19025-1048
US

V. Phone/Fax

Practice location:
  • Phone: 903-856-3633
  • Fax: 903-856-6497
Mailing address:
  • Phone: 215-441-7700
  • Fax: 215-441-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number121460
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number121460
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number115431
License Number StateTX

VIII. Authorized Official

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