Provider Demographics
NPI:1124662705
Name:SENIOR SERVICE SOLUTIONS LLC
Entity type:Organization
Organization Name:SENIOR SERVICE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-901-0104
Mailing Address - Street 1:178 SW 96TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2359
Mailing Address - Country:US
Mailing Address - Phone:954-901-0104
Mailing Address - Fax:
Practice Address - Street 1:4550 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3325
Practice Address - Country:US
Practice Address - Phone:954-901-0104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104504200Medicaid