1811344831 NPI number — NICHOLAS SENIOR SERVICES, INC.

Table of content: (NPI 1811344831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811344831 NPI number — NICHOLAS SENIOR SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NICHOLAS SENIOR SERVICES, INC.
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:
1811344831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 NW A ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANTS PASS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97526-2030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-479-2828
Provider Business Mailing Address Fax Number:
541-479-6006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 FREEMAN CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRAL POINT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97502-2426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-734-2700
Provider Business Practice Location Address Fax Number:
541-734-3220
Provider Enumeration Date:
05/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLAS
Authorized Official First Name:
INDRA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
541-479-2828

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  15-2139 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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