Provider Demographics
NPI:1346597572
Name:SENIOR CARE AMERICA
Entity Type:Organization
Organization Name:SENIOR CARE AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:HAN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-371-4191
Mailing Address - Street 1:828 ROCK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2117
Mailing Address - Country:US
Mailing Address - Phone:678-371-4191
Mailing Address - Fax:
Practice Address - Street 1:828 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-2117
Practice Address - Country:US
Practice Address - Phone:678-371-4191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-01-392-1310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility