Provider Demographics
NPI:1275872053
Name:PERRY SENIOR SERVICE
Entity Type:Organization
Organization Name:PERRY SENIOR SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:SHANTEL
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-306-6057
Mailing Address - Street 1:3 REDWALL CIR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9040
Mailing Address - Country:US
Mailing Address - Phone:912-306-6057
Mailing Address - Fax:912-349-1937
Practice Address - Street 1:3 REDWALL CIR
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-9040
Practice Address - Country:US
Practice Address - Phone:912-306-6057
Practice Address - Fax:912-349-1937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization