Provider Demographics
NPI:1376573352
Name:SENIOR RESOURCE CONNECTION
Entity Type:Organization
Organization Name:SENIOR RESOURCE CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CINDHY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:FITZWATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-223-8246
Mailing Address - Street 1:222 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-5805
Mailing Address - Country:US
Mailing Address - Phone:937-223-8246
Mailing Address - Fax:937-222-6337
Practice Address - Street 1:222 SALEM AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-5805
Practice Address - Country:US
Practice Address - Phone:937-223-8246
Practice Address - Fax:937-222-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSEFV94181Medicare ID - Type UnspecifiedPROVIDER NUMBER