Organization
COLONIAL MANOR NURSING CENTER-CLEBURNE, L.P.
Active
Other names
Colonial Manor Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER J LICARI (VICE PRESIDENT)
(215) 441-7700
Entity
Organization
Contact information
Practice address
2035 N. GRANBURY STREET, CLEBURNE, TX 76033-7460
(817) 645-9134
(817) 641-4662
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
108467
TX
332BN1400X
Nursing Facility Supplies (DME)
115703
TX
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
115703
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004525
—
TX
Enumeration date
10/14/2005
Last updated
10/26/2007
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