Provider Demographics
NPI:1851785521
Name:PLUM CREEK SPECIALTY HOSPITAL OPERATOR LLC
Entity Type:Organization
Organization Name:PLUM CREEK SPECIALTY HOSPITAL OPERATOR LLC
Other - Org Name:PLUM CREEK SPECIALTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-396-3462
Mailing Address - Street 1:111 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3342
Mailing Address - Country:US
Mailing Address - Phone:214-396-3462
Mailing Address - Fax:
Practice Address - Street 1:5601 PLUM CREEK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1801
Practice Address - Country:US
Practice Address - Phone:806-351-1000
Practice Address - Fax:806-351-8117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X, 282E00000X, 283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX352444901Medicaid
TX452066Medicare Oscar/Certification