Provider Demographics
NPI:1376687947
Name:PADUCAH SENIOR CITIZENS CENTER INC
Entity Type:Organization
Organization Name:PADUCAH SENIOR CITIZENS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN BOARD OF DIRECTORS
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-492-3305
Mailing Address - Street 1:PO BOX 782
Mailing Address - Street 2:805 RICHARDS STREET
Mailing Address - City:PADUCAH
Mailing Address - State:TX
Mailing Address - Zip Code:79248
Mailing Address - Country:US
Mailing Address - Phone:806-492-3246
Mailing Address - Fax:806-492-3246
Practice Address - Street 1:805 RICHARDS STREET
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:TX
Practice Address - Zip Code:79248
Practice Address - Country:US
Practice Address - Phone:806-492-3246
Practice Address - Fax:806-492-3246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
001D13087Medicare UPIN