Provider Demographics
NPI:1215115530
Name:SENIOR CARELINX, PA
Entity type:Organization
Organization Name:SENIOR CARELINX, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-251-1114
Mailing Address - Street 1:3880 VEST MILL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1323
Mailing Address - Country:US
Mailing Address - Phone:336-245-5407
Mailing Address - Fax:336-251-1117
Practice Address - Street 1:3880 VEST MILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1323
Practice Address - Country:US
Practice Address - Phone:336-245-5407
Practice Address - Fax:336-251-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty