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Organization
SSC CASPER OPERATING COMPANY LLC
Active
Organization
SSC CASPER OPERATING COMPANY LLC
Active
Other names
Poplar Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS P. SIMONS (SENIOR VP OPERATIONS FINANCE)
(770) 829-5100
Entity
Organization
Contact information
Practice address
4305 S POPLAR ST, CASPER, WY 82601-6106
(307) 237-2561
Mailing address
5300 W SAM HOUSTON PKWY N, SUITE 100, HOUSTON, TX 77041-5161
(832) 467-6000
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
07187
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0107451200WY
PREVIOUS MEDICAID NUMBER
WY
05
—
120859400
—
WY
Enumeration date
04/03/2007
Last updated
08/01/2013
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