Healthcare Provider Details

I. General information

NPI: 1093063034
Provider Name (Legal Business Name): SENIOR LINK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 WESLEY AVE
CINCINNATI OH
45212-2244
US

IV. Provider business mailing address

4750 WESLEY AVE
CINCINNATI OH
45212-2244
US

V. Phone/Fax

Practice location:
  • Phone: 513-531-5110
  • Fax:
Mailing address:
  • Phone: 513-531-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberRN 339599
License Number StateOH

VIII. Authorized Official

Name: MARY PEENO
Title or Position: RN
Credential:
Phone: 513-531-5110