Broadway Convalescent Center, L.P.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

113793 Issued in TX

Legal business name

BROADWAY CONVALESCENT CENTER, L.P.

Doing business as

Stonebrook Manor at Broadway

Practice address

1841 Flamingo
San Antonio, TX 78209

Phone

(210) 824-5324

Fax

(210) 824-5360

NPI assigned

Jun 26, 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

• Stonebrook Manor at Broadway Doing business as

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193270400000",
    "number": "1245267319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 DRYDEN ROAD, SUITE 2000",
            "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": "1841 FLAMINGO",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78209",
            "telephone_number": "210-824-5324",
            "fax_number": "210-824-5360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY CONVALESCENT CENTER, L.P.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2007-10-25",
        "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": "113793",
            "primary": true
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "TX",
            "license": "120074",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "TX",
            "license": "120074",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004354",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stonebrook Manor at Broadway",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Julie Elizabeth Broadbent
• Jessica Broadhead, CRNA
• Jennifer Chu Broadwater, PHARMD
• Myranda Broadwater
• Broadway Chiropractic Clinic, PC
• Broadway Healthcare LLC
• Broadway Pediatric Dentistry, PLLC
• Broadway Vascular PLLC
• Demonica Ann Broadway, LMSW
• Jeremy Brock, RRT, RCP

• Skilled Nursing Facility in San Antonio, TX
• Providers in San Antonio, 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 25, 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.