Provider Demographics
NPI:1871326835
Name:SENIOR GROUP LLC DBA ODESSACONNECT
Entity type:Organization
Organization Name:SENIOR GROUP LLC DBA ODESSACONNECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADVISOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:865-242-5004
Mailing Address - Street 1:3917 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-3213
Mailing Address - Country:US
Mailing Address - Phone:865-242-5004
Mailing Address - Fax:
Practice Address - Street 1:720 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3634
Practice Address - Country:US
Practice Address - Phone:865-242-5004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Single Specialty