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NPI Code Detail

MEDICARE: SENIOR PERSONAL CARE SOLUTIONS LLC

MEDICARE: SENIOR PERSONAL CARE SOLUTIONS 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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1386392421
Entity Type Code : Organization
Provider Name (Legal Business Name) : SENIOR PERSONAL CARE SOLUTIONS LLC
Provider Business Mailing Address
First Line : 535 EMERALD LAKE DR
Second Line :
City : FAYETTEVILLE
State : GA
Zip : 30215-5069
Country : US
Telephone Number : 770-262-6552
Fax Number :
Provider Business Practice Location Address
First Line : 535 EMERALD LAKE DR
Second Line :
City : FAYETTEVILLE
State : GA
Zip : 30215-5069
Country : US
Telephone Number : 770-262-6552
Fax Number :
Authorized Official
Title or Position : OWNER / ADMINISTRATOR
Name : TERRY WILK
Credential :
Telephone Number : 770-262-6552
Provider Enumeration Date : 03/17/2022
Last Update Date : 06/20/2022

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Directions to “SENIOR PERSONAL CARE SOLUTIONS LLC ” Practice Location

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