Provider Demographics
NPI:1467910935
Name:SENIOR NANNIES HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:SENIOR NANNIES HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOFFREDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-733-5444
Mailing Address - Street 1:3313 W COMMERCIAL BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3413
Mailing Address - Country:US
Mailing Address - Phone:954-733-5444
Mailing Address - Fax:
Practice Address - Street 1:120 S WOODLAND BLVD STE 200
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-5458
Practice Address - Country:US
Practice Address - Phone:800-748-2129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102073200Medicaid