| Organization Name: | COLONIAL MANOR NURSING CENTER-CLEBURNE, L.P. |
| NPI Number: | 1255320032 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PETER J LICARI (VICE PRESIDENT) |
| Mailing Address: | 2035 N. Granbury Street Cleburne |
| State: | TX US |
| Postal Code: | 760337460 |
| Phone Number: | 8176459134 |
| Fax Number: | 8176414662 |
| NPI Enumeration Date: | 10/14/2005 |
| NPI Last Update Date: | 10/26/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BN1400X |
| License Number: | 115703 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Nursing Facility Supplies |
| Taxonomy Definition: | |