Healthcare Provider Details

I. General information

NPI: 1932339934
Provider Name (Legal Business Name): SENIOR LIVING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 ROUSE AVE
YOUNGSVILLE PA
16371-1605
US

IV. Provider business mailing address

709 ROUSE AVE
YOUNGSVILLE PA
16371-1605
US

V. Phone/Fax

Practice location:
  • Phone: 814-563-6412
  • Fax: 814-563-9049
Mailing address:
  • Phone: 814-563-6750
  • Fax: 814-563-6751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JASEN J DILEY
Title or Position: PRESIDENT
Credential:
Phone: 814-563-6403