Provider Demographics
NPI:1184375529
Name:PLYMOUTH SENIOR SERVICES LLC
Entity type:Organization
Organization Name:PLYMOUTH SENIOR SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-414-1981
Mailing Address - Street 1:186 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1236
Mailing Address - Country:US
Mailing Address - Phone:734-414-1981
Mailing Address - Fax:
Practice Address - Street 1:186 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1236
Practice Address - Country:US
Practice Address - Phone:734-414-1981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care