Healthcare Provider Details

I. General information

NPI: 1174615223
Provider Name (Legal Business Name): SENIOR SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2895 SHOREFAIR DR
WINSTON SALEM NC
27105-4237
US

IV. Provider business mailing address

2895 SHOREFAIR DR
WINSTON SALEM NC
27105-4237
US

V. Phone/Fax

Practice location:
  • Phone: 336-725-0907
  • Fax: 336-724-2010
Mailing address:
  • Phone: 336-725-0907
  • Fax: 336-724-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberCERTIFIED
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBIN C. MODICA
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 336-721-6902