Basic Information
Provider Information | |||||||||
NPI: | 1851785521 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PLUM CREEK SPECIALTY HOSPITAL OPERATOR LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | PLUM CREEK SPECIALTY HOSPITAL | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 111 CLIFTON AVE | ||||||||
Address2: |   | ||||||||
City: | LAKEWOOD | ||||||||
State: | NJ | ||||||||
PostalCode: | 087013342 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2143963462 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 5601 PLUM CREEK DR | ||||||||
Address2: |   | ||||||||
City: | AMARILLO | ||||||||
State: | TX | ||||||||
PostalCode: | 791241801 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8063511000 | ||||||||
FaxNumber: | 8063518117 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/20/2015 | ||||||||
LastUpdateDate: | 09/22/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | NEUMAN | ||||||||
AuthorizedOfficialFirstName: | JOE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 2143963462 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X |   | TX | N |   | Hospitals | Long Term Care Hospital |   | 261QA1903X |   | TX | N |   | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 283X00000X |   | TX | Y |   | Hospitals | Rehabilitation Hospital |   |
ID Information
ID | Type | State | Issuer | Description | 352444901 | 05 | TX |   | MEDICAID |