Provider Demographics
NPI:1467580399
Name:SENIOR COMPANION SERVICES LLC
Entity Type:Organization
Organization Name:SENIOR COMPANION SERVICES LLC
Other - Org Name:SENIOR COMPANION SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-402-5567
Mailing Address - Street 1:PO BOX 1725
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1725
Mailing Address - Country:US
Mailing Address - Phone:704-402-5567
Mailing Address - Fax:
Practice Address - Street 1:212 N MULBERRY ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5138
Practice Address - Country:US
Practice Address - Phone:704-402-5567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3030251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601346Medicaid
NC3408711Medicaid