Provider Demographics
NPI:1588005318
Name:SENIOR LIVING PERSONAL CARE
Entity Type:Organization
Organization Name:SENIOR LIVING PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:CASSADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-929-8131
Mailing Address - Street 1:526 W 14TH ST # 246
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4051
Mailing Address - Country:US
Mailing Address - Phone:231-929-8131
Mailing Address - Fax:231-929-8134
Practice Address - Street 1:908 W 7TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2441
Practice Address - Country:US
Practice Address - Phone:231-929-8131
Practice Address - Fax:231-929-8134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service