SSC Boulder Operating Company LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1285 Issued in CO

Legal business name

SSC BOULDER OPERATING COMPANY LLC

Doing business as

Boulder Manor

Practice address

4685 Baseline Rd
Boulder, CO 80303-2601

Phone

(303) 494-0535

NPI assigned

Apr 1, 2007

Last updated

Nov 11, 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

• Boulder Manor Doing business as

Electronic endpoints 1

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• SSC Boulder Operating Company LLC

  dba Boulder Manor

  • Respite Care
  • Boulder, CO
  • NPI 1912494568
  NPPES parent name

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

{
    "created_epoch": "1175385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605052800000",
    "number": "1609996560",
    "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": "4685 BASELINE RD",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803032601",
            "telephone_number": "303-494-0535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSC BOULDER OPERATING COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-01",
        "last_updated": "2020-11-11",
        "certification_date": "2020-11-11",
        "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": "1285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06934242",
            "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": "Boulder Manor",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Boulder Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patric Valdon Spriggs, MA, LPC
• Christine Marie Springer, LPC
• Dean P Springstead, FNP-BC
• Spruce Street Internal Medicine
• Agnieszka Spuzak
• SSC Boulder Operating Company LLC (Boulder Manor)
• Stacy St Germain, CNT
• St. Vincent General Hospital District
• Maciej Stabile
• Lindsay Stack

• Skilled Nursing Facility in Boulder, CO
• Providers in Boulder, 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 11, 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.