Organization
SSC STATESVILLE BRIAN CENTER OPERATING COMPANY LLC
Active
Other names
Brian Center Health & Rehabilitation - Statesville
Organization subpart
No
Provider details
NPI number
Authorized official
KELLE C SANTORO (SR DIRECTOR AR)
(832) 467-5728
Entity
Organization
Contact information
Practice address
520 VALLEY ST, STATESVILLE, NC 28677-7935
(704) 873-0517
Mailing address
5300 W SAM HOUSTON PKWY N, SUITE 100, HOUSTON, TX 77041-5161
(832) 467-6000
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
NH0176
NC
313M00000X
Nursing Facility/Intermediate Care Facility
NH0176
NC
314000000X
Skilled Nursing Facility
Primary
NH0176
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3435128
—
NC
01
—
3436068
MEDICAID ICF
NC
01
—
7805464
MEDICAID REST HOME
NC
Enumeration date
03/31/2007
Last updated
04/13/2015
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