Provider Demographics
NPI:1043681463
Name:TIMELESS SENIOR CARE,LLC.
Entity type:Organization
Organization Name:TIMELESS SENIOR CARE,LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-332-0053
Mailing Address - Street 1:16343 CONNEAUT LAKE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3827
Mailing Address - Country:US
Mailing Address - Phone:814-332-0053
Mailing Address - Fax:814-332-0079
Practice Address - Street 1:16343 CONNEAUT LAKE RD STE 2
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3827
Practice Address - Country:US
Practice Address - Phone:814-332-0053
Practice Address - Fax:814-332-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA27743601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA27743601OtherDEPT. OF HEALTH HCA LICENSE #