Healthcare Provider Details

I. General information

NPI: 1174194765
Provider Name (Legal Business Name): SENIOR HOME SHARING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 S HIGHLAND AVE STE 135
LOMBARD IL
60148-6147
US

IV. Provider business mailing address

1910 S HIGHLAND AVE STE 135
LOMBARD IL
60148-6147
US

V. Phone/Fax

Practice location:
  • Phone: 630-407-0440
  • Fax:
Mailing address:
  • Phone: 630-407-0440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: RITA BROSNAN
Title or Position: EXECUTIVE DIRECTOR
Credential: LCPC
Phone: 630-407-0440