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General NPI Number Information
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NPI Number | 1003318759
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Entity Type | Organization
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Legal Business Name | SENESCENCE CARE, INC.
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 3000 ST THOMAS DR
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City | MISSOULA
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State | MT
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Zip | 59803-2946
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Country | US
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Telephone | 406-203-7972
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Fax |
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Provider Business Mailing Address
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Address Line | 714 WALKER DR
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City | MISSOULA
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State | MT
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Zip | 59804-2938
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Country | US
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Telephone | 406-360-9213
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIZABETH M ROLLE
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Credential | RDH MPH
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Telephone | 406-203-7972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 31512
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License Number State | MT
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