Provider Demographics
NPI:1770722712
Name:SENIOR NANNIES HOME CARE SERVICES, LLC
Entity type:Organization
Organization Name:SENIOR NANNIES HOME CARE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOFFREDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-733-5444
Mailing Address - Street 1:3313 W COMMERCIAL BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3413
Mailing Address - Country:US
Mailing Address - Phone:954-733-5444
Mailing Address - Fax:954-730-8349
Practice Address - Street 1:3313 W. COMMERCIAL BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309
Practice Address - Country:US
Practice Address - Phone:954-733-5444
Practice Address - Fax:954-730-8349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X
FLAHCA30211407251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
Yes251J00000XAgenciesNursing CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101343700Medicaid