Provider Demographics
NPI:1013033661
Name:SENIOR RESIDENCES, INC.
Entity Type:Organization
Organization Name:SENIOR RESIDENCES, INC.
Other - Org Name:SENIOR RESIDENCES, INC. -DOGWOOD INN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-547-3891
Mailing Address - Street 1:1380 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2934
Mailing Address - Country:US
Mailing Address - Phone:617-268-9061
Mailing Address - Fax:
Practice Address - Street 1:108 WAGNER RD
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-2923
Practice Address - Country:US
Practice Address - Phone:850-547-3891
Practice Address - Fax:850-547-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility