MEDICARE: SILVER SCREEN SENIOR 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	:	1386244465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER SCREEN SENIOR CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 15022
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90209-1022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 S BEVERLY GLEN BLVD APT 906
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5277
Country	:	US
Telephone Number	:	888-341-2224
Fax Number	:

Authorized Official
Title or Position	:	CEO/ADMINISTRATOR
Name	:	MR. STAN FOSTER
Credential	:
Telephone Number	:	888-341-2224

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/28/2020

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