SSC Beaumont Green Acres Operating Company LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

117815 Issued in TX

Legal business name

SSC BEAUMONT GREEN ACRES OPERATING COMPANY LLC

Doing business as

Pine Forest Nursing and Rehabilitation Center

Practice address

11025 Old Voth Rd
Beaumont, TX 77713-8613

Phone

(409) 892-9722

NPI assigned

Apr 3, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Thomas P. Simons

Title

Senior VP Operations Finance

Phone

(770) 829-5100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pine Forest Nursing and Rehabilitation Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379894400000",
    "number": "1750402236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 W SAM HOUSTON PKWY N",
            "address_2": "SUITE 100",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770415161",
            "telephone_number": "832-467-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11025 OLD VOTH RD",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777138613",
            "telephone_number": "409-892-9722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSC BEAUMONT GREEN ACRES OPERATING COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2013-09-23",
        "status": "A",
        "authorized_official_last_name": "SIMONS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "SENIOR VP OPERATIONS FINANCE",
        "authorized_official_telephone_number": "770-829-5100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "117815",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001013497",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Forest Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Toben Richard Squires, PTA
• Sakuntalai Srinanthakumar, M.D.
• Sringleaf Medical, LTD
• Sriya Desilva
• SS Powers Dental, P.a.
• Pamela Ann St Amand, MD
• St Elizabeth Rehab Partners, LLP
• Rayann St. Peter, LPC
• Michael Todd Stafford, M.D.
• Tamara Stafford, LVN

• Skilled Nursing Facility in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.