Provider Demographics
NPI:1326243072
Name:SSC NORTH DALLAS OPERATING COMPANY
Entity Type:Organization
Organization Name:SSC NORTH DALLAS OPERATING COMPANY
Other - Org Name:NORTH DALLAS REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP - COMPLIANCE AND AUDIT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SNELGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-443-6770
Mailing Address - Street 1:1 RAVINIA DR
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-2112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8383 MEADOW RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3701
Practice Address - Country:US
Practice Address - Phone:214-369-7811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008311314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX453032Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER