Provider Demographics
NPI:1487183125
Name:SENIOR CARE CENTER, INCOPORATED
Entity Type:Organization
Organization Name:SENIOR CARE CENTER, INCOPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:MARCELLUS
Authorized Official - Last Name:COGER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:540-483-8000
Mailing Address - Street 1:453 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-1748
Mailing Address - Country:US
Mailing Address - Phone:540-483-8000
Mailing Address - Fax:804-276-2732
Practice Address - Street 1:453 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1748
Practice Address - Country:US
Practice Address - Phone:540-483-8000
Practice Address - Fax:804-276-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1103764261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care