=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417409822
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREFERRED SENIOR CARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2016
-----------------------------------------------------
Last Update Date | 11/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24301 SOUTHLAND DR STE 214H
-----------------------------------------------------
City | HAYWARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94545-1546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-576-1211
-----------------------------------------------------
Fax | 888-818-6255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24301 SOUTHLAND DR STE 214H
-----------------------------------------------------
City | HAYWARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94545-1546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-576-1211
-----------------------------------------------------
Fax | 888-818-6255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SIEGFRIED MAXION
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-258-2367
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------