Provider Demographics
NPI:1801644901
Name:SENIOR TOTAL LIFE CARE
Entity type:Organization
Organization Name:SENIOR TOTAL LIFE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENZIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-860-8985
Mailing Address - Street 1:1875 REMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7413
Mailing Address - Country:US
Mailing Address - Phone:704-860-0600
Mailing Address - Fax:
Practice Address - Street 1:103 TR HARRIS ROAD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150
Practice Address - Country:US
Practice Address - Phone:704-874-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization