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General NPI Number Information
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NPI Number | 1710128475
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Entity Type | Organization
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Legal Business Name | SENIOR LIFE MANAGEMENT LLC
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 03/10/2009
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Provider Practice Location Address
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Address Line | 1459 INTERSTATE DR SUITE 205
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City | COOKEVILLE
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State | TN
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Zip | 38501-4608
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Country | US
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Telephone | 931-526-1127
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Fax | 931-526-1134
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Provider Business Mailing Address
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Address Line | 1459 INTERSTATE DR SUITE 205
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City | COOKEVILLE
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State | TN
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Zip | 38501-4608
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Country | US
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Telephone | 931-526-1127
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Fax | 931-526-1134
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Authorized Official
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Title or Position | FRANCHISE OWNER
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Name | MR. ROB BROWN
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Credential |
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Telephone | 931-526-1127
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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 | L000000003130
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License Number State | TN
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