Provider Demographics
NPI:1932339934
Name:SENIOR LIVING SERVICES, LLC
Entity Type:Organization
Organization Name:SENIOR LIVING SERVICES, LLC
Other - Org Name:REHAB WORKS AT ROUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-563-6403
Mailing Address - Street 1:709 ROUSE AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16371-1605
Mailing Address - Country:US
Mailing Address - Phone:814-563-6750
Mailing Address - Fax:814-563-6751
Practice Address - Street 1:709 ROUSE AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16371-1605
Practice Address - Country:US
Practice Address - Phone:814-563-6412
Practice Address - Fax:814-563-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
39-6846Medicare PIN