Wedgewood Nursing Home, L.P.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

115374 Issued in TX

Legal business name

WEDGEWOOD NURSING HOME, L.P.

Doing business as

Wedgewood Nursing Home

Practice address

6621 Dan Danciger Rd
Fort Worth, TX 76133-4905

Phone

(817) 292-6330

Fax

(817) 346-7980

NPI assigned

May 16, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Peter J Licari

Title

President of General Partner

Phone

(215) 441-7700

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Wedgewood Nursing Home Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193702400000",
    "number": "1174575625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 DRYDEN RD E",
            "city": "DRESHER",
            "state": "PA",
            "postal_code": "190251048",
            "telephone_number": "215-441-7700",
            "fax_number": "215-441-4255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6621 DAN DANCIGER RD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761334905",
            "telephone_number": "817-292-6330",
            "fax_number": "817-346-7980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEDGEWOOD NURSING HOME, L.P.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2007-10-30",
        "status": "A",
        "authorized_official_last_name": "LICARI",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT OF GENERAL PARTNER",
        "authorized_official_telephone_number": "215-441-7700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "115374",
            "primary": true
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "TX",
            "license": "115374",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "TX",
            "license": "115374",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004960",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wedgewood Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Webster, MS, CCC-SLP
• Joseph Dominic Wechsler Jr., PA-C
• Geoffrey W. Weckel, LPC
• Kati Nicole Weckman
• Ciara L Weddborn, LPC INTERN
• Wedgewood SNF LLC (Wedgewood Nursing Home)
• Wedgwood Eyecare PC (Visualeyes)
• Hannah Elizabeth Weeks
• Natalie Lillian Weeks, PT
• Rachael Weeks

• Skilled Nursing Facility in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.