Provider Demographics
NPI:1194812321
Name:SENIOR HOME CARE SERVICES, INC.
Entity type:Organization
Organization Name:SENIOR HOME CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:252-758-4556
Mailing Address - Street 1:PO BOX 7051
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-7051
Mailing Address - Country:US
Mailing Address - Phone:252-758-4556
Mailing Address - Fax:252-758-2451
Practice Address - Street 1:410 W 14TH ST
Practice Address - Street 2:SUITE A1
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4074
Practice Address - Country:US
Practice Address - Phone:252-758-4556
Practice Address - Fax:252-758-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1645251E00000X
NCHC2817251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600575Medicaid
NC3408999Medicaid
NC6601166Medicaid