Healthcare Provider Details

I. General information

NPI: 1750205266
Provider Name (Legal Business Name): SSMIB OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 7TH ST
IMPERIAL BEACH CA
91932-2106
US

IV. Provider business mailing address

740 7TH ST
IMPERIAL BEACH CA
91932-2106
US

V. Phone/Fax

Practice location:
  • Phone: 619-500-7046
  • Fax:
Mailing address:
  • Phone: 619-500-7046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW DELBRUEGGE
Title or Position: PRINCIPAL
Credential:
Phone: 314-495-1867