Provider Demographics
NPI:1225122377
Name:SENIOR SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:SENIOR SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONG
Authorized Official - Middle Name:LOR
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:763-566-5063
Mailing Address - Street 1:6500 BROOKLYN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1754
Mailing Address - Country:US
Mailing Address - Phone:763-566-5063
Mailing Address - Fax:763-315-1401
Practice Address - Street 1:6500 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-1754
Practice Address - Country:US
Practice Address - Phone:763-566-5063
Practice Address - Fax:763-315-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNNONE251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health