Provider Demographics
NPI:1265769830
Name:SENIOR SERVICE PROVIDERS OF OHIO, LLC
Entity type:Organization
Organization Name:SENIOR SERVICE PROVIDERS OF OHIO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:RALPH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:937-886-4284
Mailing Address - Street 1:3809 WILMINGTON PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5096
Mailing Address - Country:US
Mailing Address - Phone:937-886-4284
Mailing Address - Fax:888-487-5305
Practice Address - Street 1:3809 WILMINGTON PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5096
Practice Address - Country:US
Practice Address - Phone:937-886-4284
Practice Address - Fax:888-487-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health