=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851825996
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SSC BRIAN CENTER HEALTH AND REHABILITATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2017
-----------------------------------------------------
Last Update Date | 04/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 VALLEY ST
-----------------------------------------------------
City | STATESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28677-7935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-873-0517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 VALLEY ST
-----------------------------------------------------
City | STATESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28677-7935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-873-0517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | KELLE SANTORO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-873-0517
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 16163
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------