Provider Demographics
NPI:1578981981
Name:SENIORS OF NORTHERN CHESTER COUNTY, LLC
Entity Type:Organization
Organization Name:SENIORS OF NORTHERN CHESTER COUNTY, LLC
Other - Org Name:SENIORS HELPING SENIORS OF NORTHERN CHESTER COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:TROUT
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:610-590-4888
Mailing Address - Street 1:307 DEERHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:GLENMOORE
Mailing Address - State:PA
Mailing Address - Zip Code:19343-8922
Mailing Address - Country:US
Mailing Address - Phone:610-590-4888
Mailing Address - Fax:866-929-6872
Practice Address - Street 1:307 DEERHAVEN WAY
Practice Address - Street 2:
Practice Address - City:GLENMOORE
Practice Address - State:PA
Practice Address - Zip Code:19343-8922
Practice Address - Country:US
Practice Address - Phone:610-590-4888
Practice Address - Fax:866-929-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA13053601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102601871 0002OtherPROMISE (MEDICAID WAIVER)