Provider Demographics
NPI:1801823984
Name:BENBROOK NURSING & REHABILITATION CENTER, L.P.
Entity Type:Organization
Organization Name:BENBROOK NURSING & REHABILITATION CENTER, L.P.
Other - Org Name:BENBROOK NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF GENERLA 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 RD E STE 2000
Mailing Address - Street 2:
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 1:1000 MCKINLEY STREET
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126
Practice Address - Country:US
Practice Address - Phone:817-249-0020
Practice Address - Fax:817-249-6514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116637314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004606Medicaid
TX004606Medicaid