MEDICARE: SENIOR SUPPORT SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	NONE	MN

General Provider Information

NPI Number	:	1225122377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR SUPPORT SERVICES, LLC

Provider Business Mailing Address
First Line	:	6500 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1754
Country	:	US
Telephone Number	:	763-566-5063
Fax Number	:	763-315-1401

Provider Business Practice Location Address
First Line	:	6500 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1754
Country	:	US
Telephone Number	:	763-566-5063
Fax Number	:	763-315-1401

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SONG LOR ANDERSON
Credential	:	LICSW
Telephone Number	:	763-566-5063

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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