# SSC STATESVILLE MAPLE LEAF OPERATING COMPANY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Maple Leaf Health Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992825848
- **Authorized official:** KELLE C SANTORO (SR DIRECTOR AR)
- **Authorized official phone:** (832) 467-5728

## Contact information

- **Practice address:** 1101 MAPLE CARE LANE, STATESVILLE, NC 28625-8256
- **Practice address phone:** (704) 871-0705
- **Mailing address:** 5300 W SAM HOUSTON PKWY N, SUITE 100, HOUSTON, TX 77041-5161
- **Mailing address phone:** (832) 467-6000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311Z00000X | Custodial Care Facility | NH0488 | NC | — |
| 311ZA0620X | Adult Care Home Facility | NH0488 | NC | — |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH0488 | NC | — |
| 314000000X | Skilled Nursing Facility | NH0488 | NC | Yes |

## Other

- **Enumeration date:** 03/31/2007
- **Last updated:** 11/17/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3425340 | — | NC |
| 05 | — | 3426265 | — | NC |
| 05 | — | 7801592 | — | NC |