MEDICARE: SENIORSUPPORT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1750008850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIORSUPPORT LLC

Provider Business Mailing Address
First Line	:	3215 DESHLER DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-2104
Country	:	US
Telephone Number	:	513-580-6451
Fax Number	:

Provider Business Practice Location Address
First Line	:	3215 DESHLER DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-2104
Country	:	US
Telephone Number	:	513-580-6451
Fax Number	:

Authorized Official
Title or Position	:	OWNER/VICE PRESIDENT
Name	:	SURYA POUDEL
Credential	:
Telephone Number	:	469-230-6343

Provider Enumeration Date	:	10/20/2022
Last Update Date	:	10/20/2022

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Directions to “SENIORSUPPORT LLC ” Practice Location

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