Provider Demographics
NPI:1013990779
Name:SEARS PLAINS RETIREMENT CORPORATION
Entity Type:Organization
Organization Name:SEARS PLAINS RETIREMENT CORPORATION
Other - Org Name:GARRISON GERIATRIC EDUCATION AND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/ASST. CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSSWHITE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:325-691-5519
Mailing Address - Street 1:1 VILLAGE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-8231
Mailing Address - Country:US
Mailing Address - Phone:325-691-5519
Mailing Address - Fax:325-698-4582
Practice Address - Street 1:3710 4TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-5346
Practice Address - Country:US
Practice Address - Phone:806-763-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111394313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001003887Medicaid
TX675925Medicare ID - Type UnspecifiedMEDICARE