1972737039 NPI number — SSNC, INC.

Table of content: (NPI 1972737039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972737039 NPI number — SSNC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSNC, INC.
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:
ROCK CREEK HEALTH AND REHABILITATION
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:
1972737039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
824 SALEM RD STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72034-4855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-932-0050
Provider Business Mailing Address Fax Number:
501-932-0056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1414 COLLEGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SULPHUR SPRINGS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75482-3431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-932-0050
Provider Business Practice Location Address Fax Number:
501-932-0056
Provider Enumeration Date:
05/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
A
Authorized Official Middle Name:
BRANDON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-932-0050

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  127615 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001017081 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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