Provider Demographics
NPI:1952534232
Name:SENIOR COMMUNITY SERVICES
Entity Type:Organization
Organization Name:SENIOR COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITHHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-541-1019
Mailing Address - Street 1:10709 WAYZATA BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5509
Mailing Address - Country:US
Mailing Address - Phone:952-541-1019
Mailing Address - Fax:952-541-0841
Practice Address - Street 1:10709 WAYZATA BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5509
Practice Address - Country:US
Practice Address - Phone:952-541-1019
Practice Address - Fax:952-541-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN153608347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347B00000XTransportation ServicesBus