Healthcare Provider Details

I. General information

NPI: 1699772533
Provider Name (Legal Business Name): SSC COLONIAL COLUMNS CS OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 E FILLMORE ST
COLORADO SPRINGS CO
80907-6433
US

IV. Provider business mailing address

1340 E FILLMORE ST
COLORADO SPRINGS CO
80907-6433
US

V. Phone/Fax

Practice location:
  • Phone: 719-473-1105
  • Fax: 719-473-0495
Mailing address:
  • Phone: 719-473-1105
  • Fax: 719-473-0495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number0427
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0427
License Number StateCO

VIII. Authorized Official

Name: MR. GREGORY STEPHEN SHINN
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 719-473-1105