Provider Demographics
NPI:1871152793
Name:SENIOR HOME CARE, LLC
Entity type:Organization
Organization Name:SENIOR HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANYELLE
Authorized Official - Middle Name:RAYE
Authorized Official - Last Name:TIPPETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-521-2909
Mailing Address - Street 1:6007 US ROUTE 60 E STE 109
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1045
Mailing Address - Country:US
Mailing Address - Phone:304-521-2909
Mailing Address - Fax:
Practice Address - Street 1:6007 US ROUTE 60 E STE 109
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1045
Practice Address - Country:US
Practice Address - Phone:304-521-2909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care