Provider Demographics
NPI:1437149986
Name:MUNDAY NURSING CENTER, L.P.
Entity Type:Organization
Organization Name:MUNDAY NURSING CENTER, L.P.
Other - Org Name:MUNDAY NURSING 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
Mailing Address - Country:US
Mailing Address - Phone:215-441-7700
Mailing Address - Fax:215-441-4255
Practice Address - Street 1:421 W 'F' STREET
Practice Address - Street 2:
Practice Address - City:MUNDAY
Practice Address - State:TX
Practice Address - Zip Code:76371-0199
Practice Address - Country:US
Practice Address - Phone:940-422-4541
Practice Address - Fax:940-422-5244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115111314000000X
332BN1400X, 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
TX004756Medicaid
TX152702002Medicaid
TX021830701Medicaid
TX001004179Medicaid
TX152702001Medicaid
TX004756Medicaid
TX152702002Medicaid