Provider Demographics
NPI:1780674267
Name:MESQUITE NURSING CENTER, L.P.
Entity Type:Organization
Organization Name:MESQUITE NURSING CENTER, L.P.
Other - Org Name:MESQUITE TREE 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:19025-1048
Mailing Address - Country:US
Mailing Address - Phone:215-441-7700
Mailing Address - Fax:215-441-4255
Practice Address - Street 1:434 PAZA DRIVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-5198
Practice Address - Country:US
Practice Address - Phone:972-288-6489
Practice Address - Fax:972-216-1791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108463314000000X
TX115460332BN1400X, 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
TX005055Medicaid
TX4566740001Medicare NSC
TX005055Medicaid