Organization
CLYDE NURSING CENTER, L.P
Active
Other names
Clyde Nursing Center
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
806 STEPHENS ST, CLYDE, TX 79510-4554
(325) 893-4288
(325) 893-2568
Mailing address
200 DRYDEN RD E, SUITE 2000, DRESHER, PA 19025
(215) 441-7700
(215) 441-4255
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
108904
TX
332BN1400X
Nursing Facility Supplies (DME)
114462
TX
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
114462
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004395
—
TX
Enumeration date
10/12/2005
Last updated
10/26/2007
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