Healthcare Provider Details

I. General information

NPI: 1851729610
Provider Name (Legal Business Name): CORPUS CHRISTI SCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 FORTUNE DR
CORPUS CHRISTI TX
78405-3919
US

IV. Provider business mailing address

202 FORTUNE DR
CORPUS CHRISTI TX
78405-3919
US

V. Phone/Fax

Practice location:
  • Phone: 361-289-0889
  • Fax: 361-289-7516
Mailing address:
  • Phone: 361-289-0889
  • Fax: 361-289-7516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JASON PRICE
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 949-436-4343