Provider Demographics
NPI:1174850259
Name:SIXMA SENIORS
Entity Type:Organization
Organization Name:SIXMA SENIORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:V
Authorized Official - Last Name:HOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-789-5991
Mailing Address - Street 1:2766 SIXMA RD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-9575
Mailing Address - Country:US
Mailing Address - Phone:386-789-5991
Mailing Address - Fax:
Practice Address - Street 1:2766 SIXMA RD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-9575
Practice Address - Country:US
Practice Address - Phone:386-789-5991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9611310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL678003200Medicaid