Provider Demographics
NPI:1811344831
Name:NICHOLAS SENIOR SERVICES, INC.
Entity type:Organization
Organization Name:NICHOLAS SENIOR SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:INDRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-479-2828
Mailing Address - Street 1:310 NW A ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2030
Mailing Address - Country:US
Mailing Address - Phone:541-479-2828
Mailing Address - Fax:541-479-6006
Practice Address - Street 1:81 FREEMAN CT
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2426
Practice Address - Country:US
Practice Address - Phone:541-734-2700
Practice Address - Fax:541-734-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2139253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care