Organization
COLONIAL SCC LLC
Active
Other names
SCC of Colonial Oaks Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BEAL (CHIEF EXECUTIVE OFFICER)
(214) 252-7600
Entity
Organization
Contact information
Practice address
4921 MEDICAL DR, BOSSIER CITY, LA 71112-4522
(318) 742-5420
(318) 742-5420
Mailing address
600 N PEARL ST, SUITE 1100, DALLAS, TX 75201-2822
(214) 252-7600
(214) 252-7704
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1510688
—
LA
01
—
19-5604
MEDICARE PART A
LA
Enumeration date
06/16/2015
Last updated
03/03/2020
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