Provider Demographics
NPI:1689062564
Name:SENIOR INDEPENDENCE
Entity Type:Organization
Organization Name:SENIOR INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUMINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-888-7800
Mailing Address - Street 1:6520 POE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2527
Mailing Address - Country:US
Mailing Address - Phone:937-415-5666
Mailing Address - Fax:937-415-5690
Practice Address - Street 1:3003 CISCO RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-9343
Practice Address - Country:US
Practice Address - Phone:937-415-5666
Practice Address - Fax:937-425-5690
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHIO PRESBYTERIAN RETIREMENT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-31
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0157HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based