Provider Demographics
NPI:1033375720
Name:SENIOR OUTREACH SERVICES INC
Entity Type:Organization
Organization Name:SENIOR OUTREACH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LONCAR
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW,ACSW
Authorized Official - Phone:800-671-1767
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:OLD MISSION
Mailing Address - State:MI
Mailing Address - Zip Code:49673-0097
Mailing Address - Country:US
Mailing Address - Phone:800-671-1767
Mailing Address - Fax:
Practice Address - Street 1:4996 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-9754
Practice Address - Country:US
Practice Address - Phone:800-671-1767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010577971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P28120Medicare PIN
MIP24726Medicare UPIN