Healthcare Provider Details

I. General information

NPI: 1174513618
Provider Name (Legal Business Name): MONTEREY CARE CENTER, L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 10TH ST
WICHITA FALLS TX
76309-2103
US

IV. Provider business mailing address

200 DRYDEN ROAD SUITE 2000
DRESHER PA
19025
US

V. Phone/Fax

Practice location:
  • Phone: 940-766-0281
  • Fax: 940-723-4935
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 Number115322
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number115322
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number108794
License Number StateTX

VIII. Authorized Official

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