1518951128 NPI number — SENIOR CARE SERVICE LLC

Table of content: (NPI 1518951128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518951128 NPI number — SENIOR CARE SERVICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENIOR CARE SERVICE 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:
1518951128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 BROADWAY ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55413-2638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-651-6223
Provider Business Mailing Address Fax Number:
866-896-7171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
565 S COMMERCIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81505-6900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-812-0811
Provider Business Practice Location Address Fax Number:
800-880-6549
Provider Enumeration Date:
09/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GRIGGS
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
407-206-0040

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 02542390000 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 73489 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9032087 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 88103811 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 805602500 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3085727 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4996909 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6797008 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 88103811 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005603183 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012521830002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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