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General NPI Number Information
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NPI Number | 1063773935
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Entity Type | Organization
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Legal Business Name | SENIOR SERVICES PLUS
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 2603 N RODGERS AVE
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City | ALTON
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State | IL
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Zip | 62002-5524
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Country | US
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Telephone | 618-462-1391
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Fax | 618-462-7658
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Provider Business Mailing Address
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Address Line | 2603 N. RODGERS AVENUE
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City | ALTON
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State | IL
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Zip | 62002
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Country | US
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Telephone | 618-462-1391
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Fax | 618-462-7658
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Authorized Official
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Title or Position | DIRECTOR, CCP
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Name | THERESA L. COLLINS
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Credential |
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Telephone | 618-462-1391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 0012622
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 2046967
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License Number State | IL
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