Healthcare Provider Details

I. General information

NPI: 1003012089
Provider Name (Legal Business Name): SENIOR RESOURCE ASSOCIATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 08/26/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 DAVIS ST
SEBASTIAN FL
32958-3842
US

IV. Provider business mailing address

694 14TH ST
VERO BEACH FL
32960-5770
US

V. Phone/Fax

Practice location:
  • Phone: 772-569-0760
  • Fax: 772-388-6130
Mailing address:
  • Phone: 772-569-0760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: KAREN DEIGL
Title or Position: CEO
Credential:
Phone: 772-569-0760