Provider Demographics
NPI:1063773935
Name:SENIOR SERVICES PLUS
Entity type:Organization
Organization Name:SENIOR SERVICES PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CCP
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-462-1391
Mailing Address - Street 1:2603 N. RODGERS AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002
Mailing Address - Country:US
Mailing Address - Phone:618-462-1391
Mailing Address - Fax:618-462-7658
Practice Address - Street 1:2603 N RODGERS AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5524
Practice Address - Country:US
Practice Address - Phone:618-462-1391
Practice Address - Fax:618-462-7658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0012622253Z00000X
IL2046967253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0012622Medicaid