MEDICARE: SSC MONTROSE BAY OPERATING COMPANY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	12475	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609997527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SSC MONTROSE BAY OPERATING COMPANY LLC

Provider Business Mailing Address
First Line	:	5300 W SAM HOUSTON PKWY N
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77041-5161
Country	:	US
Telephone Number	:	832-467-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	22670 MAIN ST
Second Line	:
City	:	MONTROSE
State	:	AL
Zip	:	36559-0256
Country	:	US
Telephone Number	:	251-928-2177
Fax Number	:

Authorized Official
Title or Position	:	SR DIRECTOR AR
Name	:	KELLE C SANTORO
Credential	:
Telephone Number	:	832-467-5728

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	04/09/2015

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