Provider Demographics
NPI:1255897609
Name:SENIOR ONE
Entity type:Organization
Organization Name:SENIOR ONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEOPOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-599-2528
Mailing Address - Street 1:5711 164TH LN NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-5826
Mailing Address - Country:US
Mailing Address - Phone:612-599-2528
Mailing Address - Fax:
Practice Address - Street 1:5711 164TH LN NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-5826
Practice Address - Country:US
Practice Address - Phone:612-599-2528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No174200000XOther Service ProvidersMeals
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle