| Organization Name: | PALO PINTO NURSING CENTER, L.P. |
| NPI Number: | 1164412615 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PETER J LICARI (PRESIDENT OF GENERAL PARTNER) |
| Mailing Address: | 200 Sw 25th Ave Mineral Wells |
| State: | TX US |
| Postal Code: | 760678242 |
| Phone Number: | 9403257813 |
| Fax Number: | 9403255680 |
| NPI Enumeration Date: | 10/26/2005 |
| NPI Last Update Date: | 10/29/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BN1400X |
| License Number: | 121109 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Nursing Facility Supplies |
| Taxonomy Definition: | |