Provider Demographics
NPI:1235376955
Name:SENIOR CARE SERVICES PARTNERS LLC
Entity Type:Organization
Organization Name:SENIOR CARE SERVICES PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-525-2946
Mailing Address - Street 1:5025 N CENTRAL AVE
Mailing Address - Street 2:SUITE 564
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1520
Mailing Address - Country:US
Mailing Address - Phone:602-525-2946
Mailing Address - Fax:623-849-3011
Practice Address - Street 1:21 W ALTA VISTA RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5709
Practice Address - Country:US
Practice Address - Phone:602-525-2946
Practice Address - Fax:623-849-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ347396Medicaid