Provider Demographics
NPI:1083005367
Name:SENIOR SERVICES FOR SOUTH SOUND
Entity Type:Organization
Organization Name:SENIOR SERVICES FOR SOUTH SOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIESULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-586-6181
Mailing Address - Street 1:222 COLUMBIA ST NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-8208
Mailing Address - Country:US
Mailing Address - Phone:360-586-6181
Mailing Address - Fax:360-586-7408
Practice Address - Street 1:222 COLUMBIA ST NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-8208
Practice Address - Country:US
Practice Address - Phone:360-586-6181
Practice Address - Fax:360-586-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADNA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care