Provider Demographics
NPI:1174615223
Name:SENIOR SERVICES, INC.
Entity type:Organization
Organization Name:SENIOR SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MODICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-721-6902
Mailing Address - Street 1:2895 SHOREFAIR DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-4237
Mailing Address - Country:US
Mailing Address - Phone:336-725-0907
Mailing Address - Fax:336-724-2010
Practice Address - Street 1:2895 SHOREFAIR DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-4237
Practice Address - Country:US
Practice Address - Phone:336-725-0907
Practice Address - Fax:336-724-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332U00000X, 251B00000X
CERTIFIED261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No332U00000XSuppliersHome Delivered Meals
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408425Medicaid