Provider Demographics
NPI:1295039063
Name:SG SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:SG SENIOR LIVING, LLC
Other - Org Name:DARIEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-779-7608
Mailing Address - Street 1:50 LEDGE RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4439
Mailing Address - Country:US
Mailing Address - Phone:203-662-1090
Mailing Address - Fax:
Practice Address - Street 1:50 LEDGE RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4439
Practice Address - Country:US
Practice Address - Phone:203-662-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SG SENIOR LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility