Provider Demographics
NPI:1316611395
Name:SSC COLORADO SPRINGS CEDARWOOD OPERATING COMPANY LLC
Entity type:Organization
Organization Name:SSC COLORADO SPRINGS CEDARWOOD OPERATING COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR ACCOUNTS RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:KELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-467-5728
Mailing Address - Street 1:924 W KIOWA ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1424
Mailing Address - Country:US
Mailing Address - Phone:719-636-5221
Mailing Address - Fax:
Practice Address - Street 1:924 W KIOWA ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1424
Practice Address - Country:US
Practice Address - Phone:719-636-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CEDARWOOD HEALTH CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000159785Medicaid