Provider Demographics
NPI:1659075489
Name:SENIORAVENUE LLC
Entity Type:Organization
Organization Name:SENIORAVENUE LLC
Other - Org Name:SENIORAVENUE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-722-1959
Mailing Address - Street 1:1474 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702
Mailing Address - Country:US
Mailing Address - Phone:510-220-5471
Mailing Address - Fax:
Practice Address - Street 1:828 SAN PABLO AVE STE 201B
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1698
Practice Address - Country:US
Practice Address - Phone:510-722-1959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care