SSC Greeley Kenton Operating Company LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1293 Issued in CO

Legal business name

SSC GREELEY KENTON OPERATING COMPANY LLC

Doing business as

Kenton Manor

Practice address

850 27TH Ave
Greeley, CO 80634-5807

Phone

(970) 353-1018

NPI assigned

Apr 2, 2007

Last updated

Nov 16, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelle C Santoro

Title

Sr Director Ar

Phone

(832) 467-5728

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kenton Manor Doing business as

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605484800000",
    "number": "1326168212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 W SAM HOUSTON PKWY N",
            "address_2": "SUITE 100",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770415161",
            "telephone_number": "832-467-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 27TH AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806345807",
            "telephone_number": "970-353-1018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSC GREELEY KENTON OPERATING COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A",
        "authorized_official_last_name": "SANTORO",
        "authorized_official_first_name": "KELLE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "SR DIRECTOR AR",
        "authorized_official_telephone_number": "832-467-5728"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CO",
            "license": "1293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11651016",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMDR eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kenton Manor",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kenton Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Blake Alexander Squier
• Matt Squires
• Rhonda Dummit Squires, PHD FNP
• SSC Greeley Centennial Operating Company LLC (Centennial Healthcare Center)
• SSC Greeley Centennial Operating Company LLC (Centennial Healthcare Center)
• SSC Greeley Kenton Operating Company LLC (Kenton Manor)
• Samantha Stadjuhar Whitmore
• Sheldon Gregory Stadnyk, M.D.
• Katrina Raenae Staley, FNP-C
• Stephanie Rose Stamos

• Skilled Nursing Facility in Greeley, CO
• Providers in Greeley, CO by specialty
• Skilled Nursing Facility in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.