Provider Demographics
NPI:1710199336
Name:DYNAMIC SENIORS, INC.
Entity Type:Organization
Organization Name:DYNAMIC SENIORS, INC.
Other - Org Name:DYMNAMIC SENIORS ADULT DAYCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WARMKE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR-L
Authorized Official - Phone:813-973-8151
Mailing Address - Street 1:4729 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-3555
Mailing Address - Country:US
Mailing Address - Phone:813-782-8843
Mailing Address - Fax:813-782-8843
Practice Address - Street 1:4729 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-3555
Practice Address - Country:US
Practice Address - Phone:813-782-8843
Practice Address - Fax:813-782-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9000261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686150400Medicaid
FL686134200Medicaid