Provider Demographics
NPI:1285944066
Name:SENSENBACH SENIOR CARE, INC.
Entity type:Organization
Organization Name:SENSENBACH SENIOR CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:SHAYNE
Authorized Official - Last Name:SENSENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:541-330-6400
Mailing Address - Street 1:497 SW CENTURY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1167
Mailing Address - Country:US
Mailing Address - Phone:541-330-6400
Mailing Address - Fax:641-330-7362
Practice Address - Street 1:497 SW CENTURY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1167
Practice Address - Country:US
Practice Address - Phone:541-330-6400
Practice Address - Fax:641-330-7362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2201253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR521316Medicaid