Healthcare Provider Details

I. General information

NPI: 1811453079
Provider Name (Legal Business Name): SSC FORT WORTH NURSING & REHABILITATION CENTER OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 WELLESLEY AVE
FORT WORTH TX
76107-6148
US

IV. Provider business mailing address

5300 W SAM HOUSTON PKWY N STE 100
HOUSTON TX
77041-5162
US

V. Phone/Fax

Practice location:
  • Phone: 817-732-4714
  • Fax: 817-735-4118
Mailing address:
  • Phone: 832-467-5728
  • Fax: 832-467-8500

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: KELLE C SANTORO
Title or Position: SR DIRECTOR A/R
Credential:
Phone: 832-467-5728