Provider Demographics
NPI:1164973871
Name:SENIOR SOLUTIONS MANAGEMENT SERVICE
Entity Type:Organization
Organization Name:SENIOR SOLUTIONS MANAGEMENT SERVICE
Other - Org Name:SENIOR DENTAL CARE OF ALABAMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:RONI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-222-6621
Mailing Address - Street 1:1274 HUTSON DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1317
Mailing Address - Country:US
Mailing Address - Phone:251-222-6621
Mailing Address - Fax:251-308-1645
Practice Address - Street 1:1274 HUTSON DR
Practice Address - Street 2:SUITE C
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1317
Practice Address - Country:US
Practice Address - Phone:251-222-6621
Practice Address - Fax:251-308-1645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0623910305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service