Healthcare Provider Details

I. General information

NPI: 1669744215
Provider Name (Legal Business Name): SENIORS CHOICE ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2012
Last Update Date: 01/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W MAIN ST C
CAMPBELLSVILLE KY
42718-2501
US

IV. Provider business mailing address

610 W MAIN ST C
CAMPBELLSVILLE KY
42718-2501
US

V. Phone/Fax

Practice location:
  • Phone: 270-789-9869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL WARD ROBERTS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 502-472-7948