Healthcare Provider Details

I. General information

NPI: 1134568132
Provider Name (Legal Business Name): SENIORLIFESTYLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 EVERGREEN RIDGE DR
CINCINNATI OH
45215-5750
US

IV. Provider business mailing address

325 KNOLLRIDGE CT APT
FAIRFIELD OH
45014-8809
US

V. Phone/Fax

Practice location:
  • Phone: 513-948-2308
  • Fax:
Mailing address:
  • Phone: 513-600-1596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number27068634A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number148696
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number148696
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number148696
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number148696
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number27068634A
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number27068634A
License Number StateIN
# 8
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number148696
License Number StateOH

VIII. Authorized Official

Name: NICOLE SCHRENKER
Title or Position: LPN
Credential:
Phone: 513-948-2339