Healthcare Provider Details

I. General information

NPI: 1164973871
Provider Name (Legal Business Name): SENIOR SOLUTIONS MANAGEMENT SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1274 HUTSON DR SUITE C
MOBILE AL
36609-1317
US

IV. Provider business mailing address

1274 HUTSON DR SUITE C
MOBILE AL
36609-1317
US

V. Phone/Fax

Practice location:
  • Phone: 251-222-6621
  • Fax: 251-308-1645
Mailing address:
  • Phone: 251-222-6621
  • Fax: 251-308-1645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number0623910
License Number StateAL

VIII. Authorized Official

Name: MS. RONI LAND
Title or Position: PRESIDENT OF OPERATIONS
Credential:
Phone: 251-222-6621