MEDICARE: GREENVILLE 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
1	332BN1400X	Nursing Facility Supplies (DME)	115334	TX
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	115334	TX
3	314000000X	Skilled Nursing Facility	108484	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1144210741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENVILLE NURSING CENTER, L.P.

Provider Business Mailing Address
First Line	:	200 DRYDEN ROAD
Second Line	:	SUITE 2000
City	:	DRESHER
State	:	PA
Zip	:	19025-1048
Country	:	US
Telephone Number	:	215-441-7700
Fax Number	:	215-441-4255

Provider Business Practice Location Address
First Line	:	4910 WELLINGTON ST.
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-6007
Country	:	US
Telephone Number	:	903-454-3772
Fax Number	:	903-454-3881

Authorized Official
Title or Position	:	PRESIDENT OF GENERAL PARTNER
Name	:	MR. PETER J LICARI
Credential	:
Telephone Number	:	215-441-7700

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	05/29/2009

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Directions to “GREENVILLE NURSING CENTER, L.P. ” Practice Location

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