Provider Demographics
NPI:1023551520
Name:FAMILY SENIOR PARTNERSHIP, LLC
Entity Type:Organization
Organization Name:FAMILY SENIOR PARTNERSHIP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:STADNICK
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:804-798-4419
Mailing Address - Street 1:12270 MOUNT HERMON RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7807
Mailing Address - Country:US
Mailing Address - Phone:804-798-4419
Mailing Address - Fax:804-798-2265
Practice Address - Street 1:12270 MOUNT HERMON RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-7807
Practice Address - Country:US
Practice Address - Phone:804-798-4419
Practice Address - Fax:804-798-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB030908501251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0100792255Medicaid