Provider Demographics
NPI:1770071854
Name:SSC DENVER RED ROCKS OPERATING COMPANY LLC
Entity type:Organization
Organization Name:SSC DENVER RED ROCKS OPERATING COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-467-6793
Mailing Address - Street 1:5300 W SAM HOUSTON PKWY N STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-5162
Mailing Address - Country:US
Mailing Address - Phone:862-467-6000
Mailing Address - Fax:832-467-8500
Practice Address - Street 1:4450 E JEWELL AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4605
Practice Address - Country:US
Practice Address - Phone:303-757-7438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEWELL CARE CENTER OF DENVER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000159497Medicaid