Provider Demographics
NPI:1861867608
Name:SENIOR DEPOT LLC
Entity Type:Organization
Organization Name:SENIOR DEPOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-241-5113
Mailing Address - Street 1:195 FEDERAL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2556
Mailing Address - Country:US
Mailing Address - Phone:203-775-1095
Mailing Address - Fax:203-775-1098
Practice Address - Street 1:195 FEDERAL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2556
Practice Address - Country:US
Practice Address - Phone:203-775-1095
Practice Address - Fax:203-775-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1055498332B00000X, 332BN1400X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies