Provider Demographics
NPI:1891978847
Name:AHCS 3, LP
Entity Type:Organization
Organization Name:AHCS 3, LP
Other - Org Name:COPPER CREEK PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:817-919-7495
Mailing Address - Street 1:302 PEARLSTONE STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:TX
Mailing Address - Zip Code:75831
Mailing Address - Country:US
Mailing Address - Phone:903-322-4208
Mailing Address - Fax:903-322-3874
Practice Address - Street 1:302 PEARLSTONE STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:TX
Practice Address - Zip Code:75831
Practice Address - Country:US
Practice Address - Phone:903-322-4208
Practice Address - Fax:903-322-3874
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMICUS HEALTH CARE SERVICES 2, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-13
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117842314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004916Medicaid