BROADMOOR MEDICAL LODGE
NPI 1083958862
Skilled Nursing Facility in Rockwall, TX

Active since November 19, 2012CLIA 45D2051807 · Waiver
5242 MEDICAL DR, ROCKWALL, TX 75032(972) 772-8700(972) 772-8701 Get Directions Write a Review

NPPES record last updated: November 21, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Broadmoor Medical Lodge NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BROADMOOR MEDICAL LODGE (NPI 1083958862) is a healthcare organization registered as a skilled nursing facility in Rockwall, Texas and active in the NPI registry since November 2012. The organization holds a CLIA Waiver certificate valid through December 26, 2026 and lists Renee Crabb, Executive Assistant, as its authorized official.

NPPES Registry Identity

NPI1083958862
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameSCC PARTNERS, INC.
Location Address5242 MEDICAL DRRockwall, TX 75032-5001
Mailing Address1413 E I 30, Suite 7Garland, TX 75043-4784 · (972) 303-9000 · Fax (972) 303-9700
Fax(972) 772-8701
Organization SubpartYesParent: Scc Healthcare Group, Ltd.
Authorized OfficialRenee CrabbExecutive Assistant · (972) 303-7500
Enumeration DateNovember 19, 2012
Last NPPES UpdateNovember 21, 2014
NPI 1083958862 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
5242 MEDICAL DR, Rockwall, TX 75032

Other Names 1

Doing Business AsBroadmoor Medical Lodge

Other Identifiers 2

Medicare OSCAR/certification676335TX
Medicaid001021016TX

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2051807

Broadmoor Medical Lodge · Rockwall, TX
Active · expires Dec 26, 2026
CLIA Number45D2051807
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateDecember 27, 2024
Certificate Expiration DateDecember 26, 2026
Laboratory DirectorEddie C. Black
Laboratory Phone(972) 772-8700
Laboratory LocationBroadmoor Medical Lodge5242 Medical Drive, Rockwall, TX 75032
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Internal Medicine
5242 MEDICAL DR
ROCKWALL, TX 75032
Speech-Language Pathologist
5242 MEDICAL DR
ROCKWALL, TX 75032
Physical Therapist (Geriatrics)
5242 MEDICAL DR
ROCKWALL, TX 75032
Skilled Nursing Facility
5242 MEDICAL DR
ROCKWALL, TX 75032
Speech-Language Pathologist
5242 MEDICAL DR
ROCKWALL, TX 75032
Speech-Language Pathologist
5242 MEDICAL DR
ROCKWALL, TX 75032

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Scc Partners, Inc.'s NPI number?

The NPI number for Scc Partners, Inc. is 1083958862. It was assigned to this organization in the NPPES registry on November 19, 2012. The provider is doing business as Broadmoor Medical Lodge.

Where is Scc Partners, Inc. located?

Scc Partners, Inc. is located at 5242 Medical Dr, Rockwall, TX 75032. The listed phone number is (972) 772-8700.

What is Scc Partners, Inc.'s specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Scc Partners, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2051807) is associated with this NPI, valid through December 26, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Scc Partners, Inc. was last updated on November 21, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.