Provider Demographics
NPI:1750720579
Name:SENIOR THERAPY RESOURCES, INC.
Entity type:Organization
Organization Name:SENIOR THERAPY RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CEINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-322-5923
Mailing Address - Street 1:2921 WATERLEAF RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-3176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2921 WATERLEAF RD
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-3176
Practice Address - Country:US
Practice Address - Phone:719-322-5923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-15
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008120225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4532934OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
1437459401OtherSOLE PROPRIETOR NPI
IL302589185001Medicaid
ILIL5161Medicare PIN