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General NPI Number Information
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NPI Number | 1427402163
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Entity Type | Organization
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Legal Business Name | SENIOR LIFE LLC
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 109 BELVA DR
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City | VICKSBURG
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State | MS
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Zip | 39180-8928
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Country | US
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Telephone | 769-203-1773
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Fax |
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Provider Business Mailing Address
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Address Line | 109 BELVA DR
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City | VICKSBURG
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State | MS
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Zip | 39180-8928
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Country | US
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Telephone | 769-203-1773
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHENICIA SORRELS
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Credential |
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Telephone | 769-203-1773
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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 | P320988
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License Number State | MS
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