Provider Demographics
NPI:1053648931
Name:SENIOR MOMENTS HEALTHCARE INC.
Entity Type:Organization
Organization Name:SENIOR MOMENTS HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VIOLA
Authorized Official - Middle Name:T
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:615-957-1367
Mailing Address - Street 1:PO BOX 926
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37056-0926
Mailing Address - Country:US
Mailing Address - Phone:615-441-3464
Mailing Address - Fax:615-740-0738
Practice Address - Street 1:1013 LAUREL HILLS DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-4060
Practice Address - Country:US
Practice Address - Phone:615-441-3464
Practice Address - Fax:615-740-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000004616253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445069OtherTENNCARE PROVIDER #