Provider Demographics
NPI:1265027239
Name:SENIORS PLUS CASE MANAGEMENT MENTORING AND DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:SENIORS PLUS CASE MANAGEMENT MENTORING AND DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TAQUILLA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:TRAMMELL
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER/ PRESIDENT
Authorized Official - Phone:818-791-6916
Mailing Address - Street 1:5236 S CLARENDON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204-2921
Mailing Address - Country:US
Mailing Address - Phone:818-791-6916
Mailing Address - Fax:
Practice Address - Street 1:5236 S CLARENDON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-2921
Practice Address - Country:US
Practice Address - Phone:248-904-4867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health