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NPI Code Detail

MEDICARE: SSC FORT WORTH NURSING & REHABILITATION CENTER OPERATING COMPANY LLC

MEDICARE: SSC FORT WORTH NURSING & REHABILITATION CENTER 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
1314000000XSkilled Nursing Facility

Other Identifiers

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

General Provider Information

NPI Number : 1811453079
Entity Type Code : Organization
Provider Name (Legal Business Name) : SSC FORT WORTH NURSING & REHABILITATION CENTER OPERATING COMPANY LLC
Provider Business Mailing Address
First Line : 5300 W SAM HOUSTON PKWY N STE 100
Second Line :
City : HOUSTON
State : TX
Zip : 77041-5162
Country : US
Telephone Number : 832-467-5728
Fax Number : 832-467-8500
Provider Business Practice Location Address
First Line : 4825 WELLESLEY AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-6148
Country : US
Telephone Number : 817-732-4714
Fax Number : 817-735-4118
Authorized Official
Title or Position : SR DIRECTOR A/R
Name : KELLE C SANTORO
Credential :
Telephone Number : 832-467-5728
Provider Enumeration Date : 02/13/2019
Last Update Date : 11/16/2020

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