Provider Demographics
NPI:1407989643
Name:HIGH PLAINS SENIOR CARE, LLC
Entity Type:Organization
Organization Name:HIGH PLAINS SENIOR CARE, LLC
Other - Org Name:HIGH PLAINS SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-456-2574
Mailing Address - Street 1:1600 S COULTER ST BLDG F
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1710
Mailing Address - Country:US
Mailing Address - Phone:806-355-1899
Mailing Address - Fax:806-355-4312
Practice Address - Street 1:1600 S COULTER ST BLDG F
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1710
Practice Address - Country:US
Practice Address - Phone:806-355-1899
Practice Address - Fax:806-355-4312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015882251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001014259Medicaid
TX358330401Medicaid
TX001002158Medicaid
TX001002158Medicaid
TX001014260Medicaid