MEDICARE: SENIOR CENTERS INC.

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	343900000X	Non-emergency Medical Transport (VAN)
2	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1518556703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR CENTERS INC.

Provider Business Mailing Address
First Line	:	2308 JEFFERSON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-5035
Country	:	US
Telephone Number	:	419-242-9511
Fax Number	:	419-242-9513

Provider Business Practice Location Address
First Line	:	2308 JEFFERSON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-5035
Country	:	US
Telephone Number	:	419-242-9511
Fax Number	:	419-242-9513

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. SHELLY MCCOY GRISSOM
Credential	:	PHD
Telephone Number	:	419-242-9511

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	01/13/2021

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