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General NPI Number Information
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NPI Number | 1508125477
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Entity Type | Organization
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Legal Business Name | SENIOR LIFE CARE, LLC
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 3955 CENTRAL AVENUE SUITE 6
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City | HOT SPRINGS
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State | AR
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Zip | 71913
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Country | US
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Telephone | 501-525-4663
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Fax | 501-525-4705
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Provider Business Mailing Address
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Address Line | PO BOX 21640 (71903) 3955 CENTRAL AVENUE
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City | HOT SPRINGS
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State | AR
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Zip | 71913
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Country | US
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Telephone | 501-525-4663
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Fax | 501-525-4705
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Authorized Official
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Title or Position | CEO/CO-OWNER
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Name | MR. MICHAEL T. TANKERSLEY
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Credential |
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Telephone | 501-525-4663
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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 |
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License Number State |
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