Provider Demographics
NPI:1639454044
Name:SENIOR HEALTHCARE, LLC
Entity Type:Organization
Organization Name:SENIOR HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-992-1591
Mailing Address - Street 1:302 SOUTHERN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-9623
Mailing Address - Country:US
Mailing Address - Phone:316-992-1591
Mailing Address - Fax:
Practice Address - Street 1:2921 W 1ST ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-2441
Practice Address - Country:US
Practice Address - Phone:620-251-5190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74308364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100447400AMedicaid
KSR31612Medicare UPIN