Provider Demographics
NPI:1134568132
Name:SENIORLIFESTYLE
Entity type:Organization
Organization Name:SENIORLIFESTYLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRENKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-948-2339
Mailing Address - Street 1:325 KNOLLRIDGE CT
Mailing Address - Street 2:APT
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-8809
Mailing Address - Country:US
Mailing Address - Phone:513-600-1596
Mailing Address - Fax:
Practice Address - Street 1:8000 EVERGREEN RIDGE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-5750
Practice Address - Country:US
Practice Address - Phone:513-948-2308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148696282E00000X, 314000000X, 3140N1450X, 385H00000X, 311ZA0620X
IN27068634A311ZA0620X, 385H00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No282E00000XHospitalsLong Term Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child