Provider Demographics
NPI:1538515911
Name:SENIOR CARE SOURCE, INC.
Entity Type:Organization
Organization Name:SENIOR CARE SOURCE, INC.
Other - Org Name:CARE SOURCE STAFFING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:386-334-1476
Mailing Address - Street 1:213 BIRKDALE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-2053
Mailing Address - Country:US
Mailing Address - Phone:386-334-1476
Mailing Address - Fax:
Practice Address - Street 1:213 BIRKDALE DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124-2053
Practice Address - Country:US
Practice Address - Phone:386-334-1476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care