MEDICARE: PLUM CREEK CARE CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1508157181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLUM CREEK CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	1507 N ADAMS ST
Second Line	:
City	:	LEXINGTON
State	:	NE
Zip	:	68850-1243
Country	:	US
Telephone Number	:	308-324-5531
Fax Number	:	608-324-5630

Provider Business Practice Location Address
First Line	:	1507 N ADAMS ST
Second Line	:
City	:	LEXINGTON
State	:	NE
Zip	:	68850-1243
Country	:	US
Telephone Number	:	308-324-5531
Fax Number	:	608-324-5630

Authorized Official
Title or Position	:	CFO
Name	:	MICHAEL L MOORE
Credential	:
Telephone Number	:	605-642-7736

Provider Enumeration Date	:	04/29/2011
Last Update Date	:	04/29/2011

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