Provider Demographics
NPI:1790112415
Name:SENIOR FRIENDSHIP CENTERS
Entity Type:Organization
Organization Name:SENIOR FRIENDSHIP CENTERS
Other - Org Name:CASE MGNT-DESOTO
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN-IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-275-1881
Mailing Address - Street 1:5272 SUMMERLIN COMMONS WAY
Mailing Address - Street 2:SUITE 604
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2156
Mailing Address - Country:US
Mailing Address - Phone:239-275-1881
Mailing Address - Fax:239-275-1077
Practice Address - Street 1:5272 SUMMERLIN COMMONS WAY
Practice Address - Street 2:SUITE 604
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2156
Practice Address - Country:US
Practice Address - Phone:239-275-1881
Practice Address - Fax:239-275-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management