Provider Demographics
NPI:1124105986
Name:SENIOR ALLEGIANCE LLC
Entity type:Organization
Organization Name:SENIOR ALLEGIANCE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-975-1519
Mailing Address - Street 1:2501 WESTERLAND DR APT F307
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-2277
Mailing Address - Country:US
Mailing Address - Phone:713-975-1519
Mailing Address - Fax:281-881-7332
Practice Address - Street 1:2501 WESTERLAND DR APT F307
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2277
Practice Address - Country:US
Practice Address - Phone:713-975-1519
Practice Address - Fax:281-881-7332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012801251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679582Medicare Oscar/Certification