Provider Demographics
NPI:1083958862
Name:SCC PARTNERS, INC.
Entity Type:Organization
Organization Name:SCC PARTNERS, INC.
Other - Org Name:BROADMOOR MEDICAL LODGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRABB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-303-7500
Mailing Address - Street 1:1413 E I 30
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-4784
Mailing Address - Country:US
Mailing Address - Phone:972-303-9000
Mailing Address - Fax:972-303-9700
Practice Address - Street 1:5242 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5001
Practice Address - Country:US
Practice Address - Phone:972-772-8700
Practice Address - Fax:972-772-8701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCC HEALTHCARE GROUP, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-19
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001021016Medicaid
TX676335Medicare Oscar/Certification