Healthcare Provider Details

I. General information

NPI: 1346733987
Provider Name (Legal Business Name): SSC BERTHOUD OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 FRANKLIN AVE
BERTHOUD CO
80513-1158
US

IV. Provider business mailing address

5300 W SAM HOUSTON PKWY N
HOUSTON TX
77041-5161
US

V. Phone/Fax

Practice location:
  • Phone: 970-532-2683
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KEN PITTS
Title or Position: DIRECTOR REIMBURSEMENT
Credential:
Phone: 832-467-6793