Provider Demographics
NPI:1811011562
Name:SENIOR SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:SENIOR SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:G
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-638-3134
Mailing Address - Street 1:4100 REDWOOD RD
Mailing Address - Street 2:360
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2363
Mailing Address - Country:US
Mailing Address - Phone:510-638-3134
Mailing Address - Fax:510-638-3134
Practice Address - Street 1:2844 SUMMIT ST
Practice Address - Street 2:212
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3637
Practice Address - Country:US
Practice Address - Phone:510-638-3134
Practice Address - Fax:510-638-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17389174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396768883OtherINDIVIDUAL NPI
CA00G173892Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
A40070Medicare UPIN
CAZZZ31985ZMedicare ID - Type UnspecifiedGROUP NUMBER