Provider Demographics
NPI:1710129655
Name:SENIOR MANAGEMENT INC
Entity Type:Organization
Organization Name:SENIOR MANAGEMENT INC
Other - Org Name:PORT SOUTH VILLAGE- LORRAINE
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-890-7400
Mailing Address - Street 1:210 COVIL AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0711
Mailing Address - Country:US
Mailing Address - Phone:910-762-4550
Mailing Address - Fax:
Practice Address - Street 1:210 COVIL AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0711
Practice Address - Country:US
Practice Address - Phone:910-762-4550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805835Medicaid