Provider Demographics
NPI:1497041388
Name:COMPLETE SENIOR CARE
Entity Type:Organization
Organization Name:COMPLETE SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:DAFOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-285-8224
Mailing Address - Street 1:1302 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1118
Mailing Address - Country:US
Mailing Address - Phone:716-285-8224
Mailing Address - Fax:716-285-8232
Practice Address - Street 1:1302 MAIN ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1118
Practice Address - Country:US
Practice Address - Phone:716-285-8224
Practice Address - Fax:716-285-8232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03320725Medicaid