Provider Type Icon

WEDGEWOOD NURSING HOME L.P. NPI 1174575625


NPI Information

NPI: 1174575625
Provider Name: WEDGEWOOD NURSING HOME, L.P.

Doing Business As: WEDGEWOOD NURSING HOME

Classification: Skilled Nursing Facility - 314000000X
Entity Type: Organization

CLIA Number: 45D0486963

Address:
6621 DAN DANCIGER RD
FORT WORTH, TX
ZIP 76133
Phone: (817) 292-6330
Get Directions

WEDGEWOOD NURSING HOME, L.P. is a skilled nursing facility in Fort Worth, TX. The provider is (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. WEDGEWOOD NURSING HOME, L.P. NPI is 1174575625. The provider is registered as an organization entity type.
The provider Is Doing Business As Wedgewood Nursing Home.

The provider's business location address is:

6621 DAN DANCIGER RD
FORT WORTH, TX
ZIP 76133-905
Phone: (817) 292-6330
Fax: (817) 346-7980

The provider's authorized official is Peter J Licari .
The authorized official title is President Of General Partner and has the following contact phone number (215) 441-7700.

The CLIA number assigned to this NPI record is 45D0486963 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 5/16/2006 and was last updated on 10/30/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1332BN1400XDurable Medical Equipment & Medical SuppliesNursing Facility Supplies115374TEXASNo
2332BP3500XDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition115374TEXASNo
3314000000XSkilled Nursing Facility115374TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1455572MEDICARE OSCAR/CERTIFICATIONTEXAS
24531650001MEDICARE NSCTEXAS
3004960MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.