Provider Demographics
NPI:1972214146
Name:SENIOR VIRTUAL HEALTH LLC
Entity Type:Organization
Organization Name:SENIOR VIRTUAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSMEH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-992-9296
Mailing Address - Street 1:177 SQUIRREL DEN RD
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-3237
Mailing Address - Country:US
Mailing Address - Phone:910-465-2209
Mailing Address - Fax:
Practice Address - Street 1:177 SQUIRREL DEN RD
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-3237
Practice Address - Country:US
Practice Address - Phone:910-465-2209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization