Healthcare Provider Details

I. General information

NPI: 1518556703
Provider Name (Legal Business Name): SENIOR CENTERS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308 JEFFERSON AVE
TOLEDO OH
43604-5035
US

IV. Provider business mailing address

2308 JEFFERSON AVE
TOLEDO OH
43604-5035
US

V. Phone/Fax

Practice location:
  • Phone: 419-242-9511
  • Fax: 419-242-9513
Mailing address:
  • Phone: 419-242-9511
  • Fax: 419-242-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: DR. SHELLY MCCOY GRISSOM
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 419-242-9511