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NPI Code Detail

MEDICARE: PASADENA SCC LLC

MEDICARE: PASADENA SCC 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
1314000000XSkilled Nursing FacilityTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
25457 102161OTHERTXVENDOR ID/FACILITY ID

General Provider Information

NPI Number : 1659769305
Entity Type Code : Organization
Provider Name (Legal Business Name) : PASADENA SCC LLC
Provider Business Mailing Address
First Line : 600 N PEARL ST STE 1050
Second Line :
City : DALLAS
State : TX
Zip : 75201-7495
Country : US
Telephone Number : 214-252-7600
Fax Number : 214-252-7704
Provider Business Practice Location Address
First Line : 3434 WATTERS RD
Second Line :
City : PASADENA
State : TX
Zip : 77504-2015
Country : US
Telephone Number : 713-941-9155
Fax Number : 713-941-9161
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MICHAEL BEAL
Credential :
Telephone Number : 214-252-7600
Provider Enumeration Date : 01/05/2015
Last Update Date : 03/04/2020

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