Clarksville Nursing Center, L.P.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

108380 Issued in TX

Legal business name

CLARKSVILLE NURSING CENTER, L.P.

Practice address

300 E Baker St
Clarksville, TX 75426-5034

Phone

(903) 427-2236

Fax

(903) 427-5235

NPI assigned

Oct 12, 2005

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

• Clarksville Nursing Center Doing business as

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193356800000",
    "number": "1992793038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 DRYDEN RD E",
            "address_2": "SUITE 2000",
            "city": "DRESHER",
            "state": "PA",
            "postal_code": "19025",
            "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": "300 E BAKER ST",
            "city": "CLARKSVILLE",
            "state": "TX",
            "postal_code": "754265034",
            "telephone_number": "903-427-2236",
            "fax_number": "903-427-5235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSVILLE NURSING CENTER, L.P.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2007-10-26",
        "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": "108380",
            "primary": true
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "TX",
            "license": "114514",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "TX",
            "license": "114514",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004495",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarksville Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Justin Brown, NP
• William Luther Bryson, PH
• Chambers County Public Hospital District No. 1
• Charles Michael Taylor II
• Clarksville I.S.D.
• Clarksville Pharmacy LLC
• Bobby S. Conway, M.S. LPC
• Core Health Systems
• Country Home Care, Inc.
• CVS Pharmacy Inc

• Skilled Nursing Facility in Clarksville, TX
• Providers in Clarksville, 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 26, 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.