Healthcare Provider Details

I. General information

NPI: 1255119210
Provider Name (Legal Business Name): SENIOR SUPPORTSYSTEM HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8329 BELLS LAKE RD
APEX NC
27539-8382
US

IV. Provider business mailing address

8329 BELLS LAKE RD
APEX NC
27539-8382
US

V. Phone/Fax

Practice location:
  • Phone: 919-931-6701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MANZARUL ISLAM
Title or Position: OWNER
Credential:
Phone: 919-931-6701