Provider Demographics
NPI:1114314366
Name:MANAGED SENIOR CARE LLC
Entity Type:Organization
Organization Name:MANAGED SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-234-0190
Mailing Address - Street 1:PO BOX 140288
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49514-0288
Mailing Address - Country:US
Mailing Address - Phone:616-234-0190
Mailing Address - Fax:866-289-0994
Practice Address - Street 1:625 SPRING AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1903
Practice Address - Country:US
Practice Address - Phone:616-234-0190
Practice Address - Fax:866-289-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No347C00000XTransportation ServicesPrivate Vehicle