Provider Demographics
NPI:1790702728
Name:SENIOR EXECUTIVE LLC
Entity Type:Organization
Organization Name:SENIOR EXECUTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ZUCKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-882-0903
Mailing Address - Street 1:7027 N SCOTTSDALE RD
Mailing Address - Street 2:UNIT 115
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3682
Mailing Address - Country:US
Mailing Address - Phone:480-882-0903
Mailing Address - Fax:480-882-0903
Practice Address - Street 1:7027 N SCOTTSDALE RD
Practice Address - Street 2:UNIT 115
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-3682
Practice Address - Country:US
Practice Address - Phone:480-882-0903
Practice Address - Fax:480-882-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20112658332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies