Colonial SCC LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

COLONIAL SCC LLC

Doing business as

SCC of Colonial Oaks Rehabilitation Center

Practice address

4921 Medical Dr
Bossier City, LA 71112-4522

Phone

(318) 742-5420

Fax

(318) 742-5420

NPI assigned

Jun 16, 2015

Organization subpart

No

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

Authorized official

Name

Michael Beal

Title

Chief Executive Officer

Phone

(214) 252-7600

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• SCC of Colonial Oaks Rehabilitation Center Doing business as

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

{
    "created_epoch": "1434412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583193600000",
    "number": "1699156513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 N PEARL ST",
            "address_2": "SUITE 1100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752012822",
            "telephone_number": "214-252-7600",
            "fax_number": "214-252-7704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4921 MEDICAL DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711124522",
            "telephone_number": "318-742-5420",
            "fax_number": "318-742-5420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONIAL SCC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-16",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A",
        "authorized_official_last_name": "BEAL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "214-252-7600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1510688",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART A",
            "identifier": "19-5604",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SCC of Colonial Oaks Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SCC of Colonial Oaks Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sara G Coleman, LMT #8705
• Dawn V Collins
• Cricket Collinsworth, M.S., CCC-SLP
• Monica N Collinsworth, CRNA
• Colonial Oaks Guest Care Center, LLC
• Courtney Elizabeth Colvin, M.C.D. CCC-SLP
• Jasmine Colvin
• Renae Fincher Colwick, MA, CCC-SLP
• Teresa Nakai Combs, CNA-CAREGIVER
• Commcare Corporation

• Skilled Nursing Facility in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Skilled Nursing Facility in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 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.