=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316513179
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENIOR LIFE CARE SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2021
-----------------------------------------------------
Last Update Date | 04/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1928 SW PINEWOOD WAY
-----------------------------------------------------
City | PALM CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34990-1364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-485-1112
-----------------------------------------------------
Fax | 772-382-2888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1928 SW PINEWOOD WAY
-----------------------------------------------------
City | PALM CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34990-1364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-485-1112
-----------------------------------------------------
Fax | 772-382-2888
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANN GEISMAR
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 772-212-2115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------