Healthcare Provider Details

I. General information

NPI: 1487183125
Provider Name (Legal Business Name): SENIOR CARE CENTER, INCOPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 S MAIN ST
ROCKY MOUNT VA
24151-1748
US

IV. Provider business mailing address

453 S MAIN ST
ROCKY MOUNT VA
24151-1748
US

V. Phone/Fax

Practice location:
  • Phone: 540-483-8000
  • Fax: 804-276-2732
Mailing address:
  • Phone: 540-483-8000
  • Fax: 804-276-2732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1103764
License Number StateVA

VIII. Authorized Official

Name: CLIFTON MARCELLUS COGER
Title or Position: DIRECTOR
Credential: CPA
Phone: 540-483-8000