Healthcare Provider Details

I. General information

NPI: 1851796163
Provider Name (Legal Business Name): SENIOR MOMENTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 KINGSBURY AVE
TOLLAND CT
06084
US

IV. Provider business mailing address

750 MAIN ST
MANCHESTER CT
06040-5101
US

V. Phone/Fax

Practice location:
  • Phone: 860-926-4515
  • Fax: 860-926-4517
Mailing address:
  • Phone: 860-643-9500
  • Fax: 860-643-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LORI J O'CONNOR
Title or Position: DIRECTOR/OWNER
Credential: RN
Phone: 860-643-9500