1760503353 NPI number — SSC FOREST HILL OPERATING COMPANY LLC

Table of content: (NPI 1760503353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760503353 NPI number — SSC FOREST HILL OPERATING COMPANY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSC FOREST HILL OPERATING COMPANY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FOREST HILL HEALTH AND REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760503353
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 W SAM HOUSTON PKWY N
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77041-5161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-467-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 FOREST VALLEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST HILL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21050-2831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-893-2468
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANTORO
Authorized Official First Name:
KELLE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
SR DIRECTOR AR
Authorized Official Telephone Number:
832-467-5728

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  12-007 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 406156000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 407310000 . This is a "MEDICAID CO-INS ONLY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com