Provider Demographics
NPI:1174509731
Name:SSC FOREST CITY OPERATING COMPANY, LLC
Entity Type:Organization
Organization Name:SSC FOREST CITY OPERATING COMPANY, LLC
Other - Org Name:FOREST CITY HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIR, ACCTS RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:KELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANTORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-467-5728
Mailing Address - Street 1:5300 W. SAM HOUSTON PKY N.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041
Mailing Address - Country:US
Mailing Address - Phone:832-467-6000
Mailing Address - Fax:832-467-5528
Practice Address - Street 1:830 BETHANY CHURCH RD
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-8106
Practice Address - Country:US
Practice Address - Phone:828-245-2852
Practice Address - Fax:828-248-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
311Z00000X, 314000000X
NCNH0474314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3415314Medicaid
NC3415314Medicaid