1376118851 NPI number — THE SENIOR ENRICHMENT CENTER, LLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376118851 NPI number — THE SENIOR ENRICHMENT CENTER, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SENIOR ENRICHMENT CENTER, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376118851
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2828 PICKETT RD STE 250A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27705-5879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-748-3410
Provider Business Mailing Address Fax Number:
919-964-3124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 W MAIN ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27889-4878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
984-234-9632
Provider Business Practice Location Address Fax Number:
919-964-3124
Provider Enumeration Date:
05/26/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PARKS
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
BURGESS
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
919-748-3410

Provider Taxonomy Codes

  • Taxonomy code: 174200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)