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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