Provider Demographics
NPI:1003012089
Name:SENIOR RESOURCE ASSOCIATION, INC
Entity type:Organization
Organization Name:SENIOR RESOURCE ASSOCIATION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEIGL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-569-0760
Mailing Address - Street 1:694 14TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5770
Mailing Address - Country:US
Mailing Address - Phone:772-569-0760
Mailing Address - Fax:
Practice Address - Street 1:815 DAVIS ST
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3842
Practice Address - Country:US
Practice Address - Phone:772-569-0760
Practice Address - Fax:772-388-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No332U00000XSuppliersHome Delivered Meals
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL087748401Medicaid
FL087748400Medicaid
FL087748402Medicaid
FL087748403Medicaid