Provider Demographics
NPI:1124327655
Name:LARSEN SENIOR CARE LLC
Entity type:Organization
Organization Name:LARSEN SENIOR CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-565-8901
Mailing Address - Street 1:600 N JACKSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2561
Mailing Address - Country:US
Mailing Address - Phone:610-565-8901
Mailing Address - Fax:610-565-8905
Practice Address - Street 1:600 N JACKSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2561
Practice Address - Country:US
Practice Address - Phone:610-565-8901
Practice Address - Fax:610-565-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11333601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care