Provider Demographics
NPI:1073392692
Name:SENIOR LIFECARE INC
Entity Type:Organization
Organization Name:SENIOR LIFECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AJARATU
Authorized Official - Middle Name:M
Authorized Official - Last Name:AJANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-837-6006
Mailing Address - Street 1:2727 STOCKBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7829
Mailing Address - Country:US
Mailing Address - Phone:708-376-0067
Mailing Address - Fax:
Practice Address - Street 1:109 MEYER FARM RD
Practice Address - Street 2:
Practice Address - City:ARNOLDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30619-1532
Practice Address - Country:US
Practice Address - Phone:706-899-0321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility