Organization
SSC PLEASANT PRAIRIE OPERATING COMPANY LLC
Active
Other names
Grande Prairie Health and Rehabilitation 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
10330 PRAIRIE RIDGE BLVD, PLEASANT PRAIRIE, WI 53158-1947
(262) 612-2800
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
5005
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20186700WI
PREVIOUS MEDICAID NUMBER
WI
05
—
20194800
—
WI
Enumeration date
04/03/2007
Last updated
11/17/2020
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