Provider Demographics
NPI:1184799900
Name:SENIOR AND ADULT CARE LLC
Entity type:Organization
Organization Name:SENIOR AND ADULT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WETHAK
Authorized Official - Middle Name:TAWFIQ
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-785-9900
Mailing Address - Street 1:11400 BURNSIDE PL
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22551-4617
Mailing Address - Country:US
Mailing Address - Phone:540-785-9900
Mailing Address - Fax:540-785-9960
Practice Address - Street 1:11400 BURNSIDE PL
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-4617
Practice Address - Country:US
Practice Address - Phone:540-785-9900
Practice Address - Fax:540-785-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005879761OtherVA PREMIER
VA007596117Medicaid
VADC9013OtherRAIL ROAD MEDICARE
VAC08564Medicare ID - Type Unspecified