Provider Demographics
NPI:1831114446
Name:51 THE PLAINS, INC.
Entity Type:Organization
Organization Name:51 THE PLAINS, INC.
Other - Org Name:HICKORY CREEK NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-204-1040
Mailing Address - Street 1:782 W ORANGE RD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-8922
Mailing Address - Country:US
Mailing Address - Phone:440-204-1040
Mailing Address - Fax:
Practice Address - Street 1:51 E 4TH ST
Practice Address - Street 2:
Practice Address - City:THE PLAINS
Practice Address - State:OH
Practice Address - Zip Code:45780-1346
Practice Address - Country:US
Practice Address - Phone:740-797-4561
Practice Address - Fax:740-797-3614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1731314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2667065Medicaid
OH365589Medicare Oscar/Certification