Provider Demographics
NPI:1679023147
Name:SENIOR COMMUNITY BASED SERVICES CORP
Entity Type:Organization
Organization Name:SENIOR COMMUNITY BASED SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ CUERVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-701-6007
Mailing Address - Street 1:1840 W 49TH ST STE 311
Mailing Address - Street 2:APT 103
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2978
Mailing Address - Country:US
Mailing Address - Phone:786-970-8480
Mailing Address - Fax:
Practice Address - Street 1:1840 W 49TH ST STE 311
Practice Address - Street 2:APT 103
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2978
Practice Address - Country:US
Practice Address - Phone:786-970-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234592251C00000X, 253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No385H00000XRespite Care FacilityRespite Care