Provider Demographics
NPI:1134550387
Name:SENIOR MOMENTS HOME HEALTH, INC.
Entity type:Organization
Organization Name:SENIOR MOMENTS HOME HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/VP
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAVAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-323-6100
Mailing Address - Street 1:216 N 3RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5197
Mailing Address - Country:US
Mailing Address - Phone:352-323-6100
Mailing Address - Fax:352-323-6130
Practice Address - Street 1:216 N 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5197
Practice Address - Country:US
Practice Address - Phone:352-323-6100
Practice Address - Fax:352-323-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA 299993225251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health