Provider Demographics
NPI:1215320684
Name:SINGLE SOURCE FOR SENIORS, LLC
Entity type:Organization
Organization Name:SINGLE SOURCE FOR SENIORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-280-5597
Mailing Address - Street 1:PO BOX 150447
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63115-8447
Mailing Address - Country:US
Mailing Address - Phone:770-280-5597
Mailing Address - Fax:
Practice Address - Street 1:5572 CLEMENS PL
Practice Address - Street 2:SUITE 2E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-3059
Practice Address - Country:US
Practice Address - Phone:770-280-5597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health