Provider Demographics
NPI:1730311556
Name:SENIOR HOUSING MANAGEMENT PROVIDER LLC
Entity Type:Organization
Organization Name:SENIOR HOUSING MANAGEMENT PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:KANETI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-659-9330
Mailing Address - Street 1:534 DATURA ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5308
Mailing Address - Country:US
Mailing Address - Phone:561-659-9330
Mailing Address - Fax:561-659-0732
Practice Address - Street 1:534 DATURA ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5308
Practice Address - Country:US
Practice Address - Phone:561-659-9330
Practice Address - Fax:561-659-0732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7617310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility