Provider Demographics
NPI:1811235120
Name:SENIOR HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:SENIOR HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:502-883-1015
Mailing Address - Street 1:2932 BRECKENRIDGE LN
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1400
Mailing Address - Country:US
Mailing Address - Phone:502-883-1015
Mailing Address - Fax:502-883-1019
Practice Address - Street 1:2932 BRECKENRIDGE LN
Practice Address - Street 2:SUITE 5
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1400
Practice Address - Country:US
Practice Address - Phone:502-883-1015
Practice Address - Fax:502-883-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100240490Medicaid
KY7100240490Medicaid