Provider Demographics
NPI:1891078135
Name:SENIOR RESOURCES HEALTHCARE SERVICES,LLC
Entity Type:Organization
Organization Name:SENIOR RESOURCES HEALTHCARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:769-798-3490
Mailing Address - Street 1:623 ORCHID CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-2427
Mailing Address - Country:US
Mailing Address - Phone:769-798-3490
Mailing Address - Fax:601-991-1909
Practice Address - Street 1:623 ORCHID CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-2427
Practice Address - Country:US
Practice Address - Phone:769-798-3490
Practice Address - Fax:601-991-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05150307385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04775206OtherMEDICAID ELDERLY AND DISABLED WAIVER PROGRAM (RESPITE)
MS05150307OtherMEDICAID ELDERLY AND DISABLED WAIVER PROGRAM ( HOMEMAKER)