MEDICARE: SENIOR SUPPORTSYSTEM HOME CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1255119210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR SUPPORTSYSTEM HOME CARE LLC

Provider Business Mailing Address
First Line	:	8329 BELLS LAKE RD
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27539-8382
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8329 BELLS LAKE RD
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27539-8382
Country	:	US
Telephone Number	:	919-931-6701
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MANZARUL ISLAM
Credential	:
Telephone Number	:	919-931-6701

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	09/20/2023

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