Healthcare Provider Details

I. General information

NPI: 1740157072
Provider Name (Legal Business Name): SENIOR BEATS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 E FAIRFIELD RD STE 107
GREENVILLE SC
29605-3688
US

IV. Provider business mailing address

716 E FAIRFIELD RD STE 107
GREENVILLE SC
29605-3688
US

V. Phone/Fax

Practice location:
  • Phone: 864-419-0167
  • Fax:
Mailing address:
  • Phone: 864-419-0167
  • Fax:

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: MS. GWENDOLYN JACKSON
Title or Position: ADMINISTRATOR
Credential: MBA LCSW
Phone: 864-419-0167