Provider Demographics
NPI:1316601099
Name:SENIOR LIFE CARE & FAMILY AGENCY LLC
Entity Type:Organization
Organization Name:SENIOR LIFE CARE & FAMILY AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADWOA
Authorized Official - Middle Name:
Authorized Official - Last Name:NYAMEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-677-6660
Mailing Address - Street 1:4 TRELLIS DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8212
Mailing Address - Country:US
Mailing Address - Phone:703-677-6660
Mailing Address - Fax:
Practice Address - Street 1:11724 MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7300
Practice Address - Country:US
Practice Address - Phone:703-677-6660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health