Provider Demographics
NPI:1043268469
Name:RIVER OAKS CARE CENTER, L.P.
Entity Type:Organization
Organization Name:RIVER OAKS CARE CENTER, L.P.
Other - Org Name:RIVER OAKS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:LICARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-441-7700
Mailing Address - Street 1:200 DRYDEN ROAD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1048
Mailing Address - Country:US
Mailing Address - Phone:215-441-7700
Mailing Address - Fax:215-441-4255
Practice Address - Street 1:100 BAILEY STREET
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-6927
Practice Address - Country:US
Practice Address - Phone:940-766-0279
Practice Address - Fax:940-767-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114740314000000X
TX121276332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004322Medicaid
TX675029Medicare Oscar/Certification
TX4548100001Medicare NSC