=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265621908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ON SITE FOR SENIORS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2007
-----------------------------------------------------
Last Update Date | 01/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 296 W SUNSET AVE STE 14
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83815-8367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-967-4771
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 238
-----------------------------------------------------
City | HAYDEN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83835-0238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-967-4771
-----------------------------------------------------
Fax | 208-683-8101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RENDERING PHYSICIAN
-----------------------------------------------------
Name | SUSAN MELCHIORE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 208-967-4771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------