Provider Demographics
NPI:1033102140
Name:SSC HOLDINGS LLC
Entity type:Organization
Organization Name:SSC HOLDINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-775-8019
Mailing Address - Street 1:81812 DR CARREON BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-775-2225
Mailing Address - Fax:760-775-2377
Practice Address - Street 1:81812 DR CARREON BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-775-2225
Practice Address - Fax:760-775-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000805261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05C0001681Medicare UPIN
CAZZZ30421ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
05C0001681Medicare UPIN