SSC Pueblo Operating Company LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0004 Issued in CO

Legal business name

SSC PUEBLO OPERATING COMPANY LLC

Doing business as

Minnequa Medicenter

Practice address

2701 California St
Pueblo, CO 81004-3869

Phone

(719) 561-1300

NPI assigned

Apr 3, 2007

Last updated

Nov 17, 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 2

Addresses

Other identifiers 2

Other names 1

• Minnequa Medicenter 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 Pueblo Operating Company LLC

  dba Minnequa Medicenter

  • Respite Care
  • Pueblo, CO
  • NPI 1235620840
  NPPES parent name

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605571200000",
    "number": "1881715910",
    "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": "2701 CALIFORNIA ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043869",
            "telephone_number": "719-561-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSC PUEBLO OPERATING COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "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": "0004",
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "CO",
            "license": "0004",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01627015",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "53273761",
            "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": "Minnequa Medicenter",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Minnequa Medicenter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stevie Nichole Spurlin, PA
• Havilah R. Spurlock, FNP-C
• Lynn Squier
• SSC Pueblo Belmont Operating Company LLC (Belmont Lodge Health Care Center)
• SSC Pueblo Operating Company LLC (Minnequa Medicenter)
• Lesli St. John, LPC, LAC
• John Stachler, M.D.
• Nathan Stacy, FNP-C
• Lucinei Geraldo Stadnik, MD
• Brittany Stadterman, PA

• Skilled Nursing Facility in Pueblo, CO
• Providers in Pueblo, 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 17, 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.