Provider Demographics
NPI:1104423862
Name:LEE SENIOR SERVICES, LLC
Entity type:Organization
Organization Name:LEE SENIOR SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCHILL
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:239-349-3296
Mailing Address - Street 1:9800 S HEALTHPARK DR STE 310
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3630
Mailing Address - Country:US
Mailing Address - Phone:239-349-3300
Mailing Address - Fax:239-418-2540
Practice Address - Street 1:16451 HEALTHPARK COMMONS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9501
Practice Address - Country:US
Practice Address - Phone:239-349-3300
Practice Address - Fax:239-418-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty