Provider Demographics
NPI:1720059561
Name:DORCHESTER SENIORS, INC.
Entity Type:Organization
Organization Name:DORCHESTER SENIORS, INC.
Other - Org Name:DORCHESTER HUMAN DEVELOPMENT BOARD, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISWCP
Authorized Official - Phone:843-871-5053
Mailing Address - Street 1:312 N LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6543
Mailing Address - Country:US
Mailing Address - Phone:843-871-5053
Mailing Address - Fax:843-821-2693
Practice Address - Street 1:312 N LAUREL ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6543
Practice Address - Country:US
Practice Address - Phone:843-871-5053
Practice Address - Fax:843-821-2693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0478Medicaid