Organization
BROADWAY CONVALESCENT CENTER, L.P.
Active
Other names
Stonebrook Manor at Broadway
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER J LICARI (PRESIDENT OF GENERAL PARTNER)
(215) 441-7700
Entity
Organization
Contact information
Practice address
1841 FLAMINGO, SAN ANTONIO, TX 78209
(210) 824-5324
(210) 824-5360
Mailing address
200 DRYDEN ROAD, SUITE 2000, DRESHER, PA 19025-1048
(215) 441-7700
(215) 441-4255
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
113793
TX
332BN1400X
Nursing Facility Supplies (DME)
120074
TX
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
120074
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004354
—
TX
Enumeration date
06/26/2006
Last updated
10/25/2007
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