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General NPI Number Information
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NPI Number | 1750402236
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Entity Type | Organization
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Legal Business Name | SSC BEAUMONT GREEN ACRES OPERATING COMPANY LLC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 11025 OLD VOTH RD
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City | BEAUMONT
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State | TX
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Zip | 77713-8613
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Country | US
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Telephone | 409-892-9722
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Fax |
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Provider Business Mailing Address
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Address Line | 5300 W SAM HOUSTON PKWY N SUITE 100
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City | HOUSTON
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State | TX
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Zip | 77041-5161
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Country | US
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Telephone | 832-467-6000
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Fax |
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Authorized Official
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Title or Position | SENIOR VP OPERATIONS FINANCE
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Name | THOMAS P. SIMONS
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Credential |
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Telephone | 770-829-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 117815
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License Number State | TX
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