SSC Kenesaw Operating Company LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

014003 Issued in NE

Legal business name

SSC KENESAW OPERATING COMPANY LLC

Practice address

100 W Elm St
Kenesaw, NE 68956-1543

Phone

(402) 752-3212

NPI assigned

Apr 2, 2007

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

• Haven Home Doing business as

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428883200000",
    "number": "1609997287",
    "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": "100 W ELM ST",
            "city": "KENESAW",
            "state": "NE",
            "postal_code": "689561543",
            "telephone_number": "402-752-3212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSC KENESAW OPERATING COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2015-04-13",
        "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": "NE",
            "license": "014003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100252444-00",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Haven Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Guardian Angel Life Services, Inc
• Kenesaw Public Schools
• Brian Scott Ortgies
• Premier Estates of Kenesaw, LLC
• Matthew Brian Reiman
• Mark Dale Stubblefield
• Roberta Irene Stubblefield
• The Mary Lanning Memorial Hospital Association
• Jody Uden
• Chance L Widener

• All providers in Kenesaw, NE
• Skilled Nursing Facility in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2015; 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.