Provider Demographics
NPI:1710117239
Name:MIDVALLEY SENIORS,INC.
Entity Type:Organization
Organization Name:MIDVALLEY SENIORS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:ROUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-892-6114
Mailing Address - Street 1:11975 W MID VALLEY WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-0634
Mailing Address - Country:US
Mailing Address - Phone:907-892-6114
Mailing Address - Fax:907-892-7972
Practice Address - Street 1:11975 W MID VALLEY WAY
Practice Address - Street 2:SUITE A
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-0634
Practice Address - Country:US
Practice Address - Phone:907-892-6114
Practice Address - Fax:907-892-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals