Active NPI
SSC Boulder Operating Company LLC
Doing business as Boulder Manor
- Respite Care
- Boulder, CO
National Provider Identifier
1912494568
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Respite Care
- License
- 1285
- 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
- Fax
- (303) 494-0162
- NPI assigned
- Apr 19, 2018
- Organization subpart
- Yes
- Parent organization
- SSC BOULDER OPERATING COMPANY LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ken Pitts
- Title
- Director Reimbursement
- Phone
- (832) 467-6793
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Respite Care | 385H00000X | 1285 | CO | Primary |
Addresses
Primary practice location
4685 Baseline Rd
Boulder, CO 80303-2601
Mailing address
5300 W Sam Houston Pkwy N Ste 100
Houston, TX 77041-5162
Phone (832) 467-6000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9000159952 | Medicaid | CO |
Other names 1
- Boulder Manor
National Provider Directory
National Provider Directory- Part of
- SSC Boulder Operating Company LLC
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
dba Boulder Manor
- Skilled Nursing Facility
- Boulder, CO
- NPI 1609996560
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524096000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1524096000000",
"number": "1912494568",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5300 W SAM HOUSTON PKWY N STE 100",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770415162",
"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",
"fax_number": "303-494-0162"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SSC BOULDER OPERATING COMPANY LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SSC BOULDER OPERATING COMPANY LLC",
"enumeration_date": "2018-04-19",
"last_updated": "2018-04-19",
"status": "A",
"authorized_official_last_name": "PITTS",
"authorized_official_first_name": "KEN",
"authorized_official_title_or_position": "DIRECTOR REIMBURSEMENT",
"authorized_official_telephone_number": "832-467-6793"
},
"taxonomies": [
{
"code": "385H00000X",
"taxonomy_group": "",
"desc": "Respite Care",
"state": "CO",
"license": "1285",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9000159952",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Boulder Manor",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Boulder Manor",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.