Provider Demographics
NPI:1497402978
Name:SENIOR RESIDENCE SERVICES LLC
Entity Type:Organization
Organization Name:SENIOR RESIDENCE SERVICES LLC
Other - Org Name:NOMOLI HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-369-5533
Mailing Address - Street 1:5506 S FORT APACHE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7673
Mailing Address - Country:US
Mailing Address - Phone:702-369-5533
Mailing Address - Fax:702-369-2018
Practice Address - Street 1:5506 S FORT APACHE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7673
Practice Address - Country:US
Practice Address - Phone:702-369-5533
Practice Address - Fax:702-369-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health