# COLONIAL SCC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SCC of Colonial Oaks Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699156513
- **Authorized official:** MICHAEL BEAL (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (214) 252-7600

## Contact information

- **Practice address:** 4921 MEDICAL DR, BOSSIER CITY, LA 71112-4522
- **Practice address phone:** (318) 742-5420
- **Practice address fax:** (318) 742-5420
- **Mailing address:** 600 N PEARL ST, SUITE 1100, DALLAS, TX 75201-2822
- **Mailing address phone:** (214) 252-7600
- **Mailing address fax:** (214) 252-7704

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 06/16/2015
- **Last updated:** 03/03/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1510688 | — | LA |
| 01 | — | 19-5604 | MEDICARE PART A | LA |