Provider Demographics
NPI:1467037457
Name:XENNIAL SENIOR CARE SERVICES LLC
Entity Type:Organization
Organization Name:XENNIAL SENIOR CARE SERVICES LLC
Other - Org Name:A PLACE AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-398-9925
Mailing Address - Street 1:482 WOODPECKER FOREST LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3757
Mailing Address - Country:US
Mailing Address - Phone:651-398-9925
Mailing Address - Fax:
Practice Address - Street 1:945 SGT ED HOLCOMB BLVD S STE 20
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1130
Practice Address - Country:US
Practice Address - Phone:936-703-8394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health