Provider Demographics
NPI:1194140434
Name:SENIOR LIFE INC.
Entity type:Organization
Organization Name:SENIOR LIFE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-364-2578
Mailing Address - Street 1:PO BOX 8218
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64508-8218
Mailing Address - Country:US
Mailing Address - Phone:816-364-2578
Mailing Address - Fax:816-364-3430
Practice Address - Street 1:1616 WEISENBORN RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2527
Practice Address - Country:US
Practice Address - Phone:816-232-9874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QOL HEALTH MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-24
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
MO040562314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO102051604Medicaid