Provider Demographics
NPI:1659368819
Name:SSC NEW BEDFORD OPERATING COMPANY, LLC
Entity Type:Organization
Organization Name:SSC NEW BEDFORD OPERATING COMPANY, LLC
Other - Org Name:SOUTHEASTERN MASSACHUSETTS HEALTH & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR AR
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 PKWY N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-5161
Mailing Address - Country:US
Mailing Address - Phone:832-467-6000
Mailing Address - Fax:
Practice Address - Street 1:4586 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-4715
Practice Address - Country:US
Practice Address - Phone:508-998-1188
Practice Address - Fax:508-985-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026386AMedicaid
MA0920941Medicaid
MA0928062MAOtherPREVIOUS MEDICAID NUMBER
MA0928062MAOtherPREVIOUS MEDICAID NUMBER