Provider Demographics
NPI:1316121890
Name:SENIOR SUPPORT
Entity type:Organization
Organization Name:SENIOR SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISTI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-487-5966
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-0474
Mailing Address - Country:US
Mailing Address - Phone:817-487-5966
Mailing Address - Fax:817-556-0394
Practice Address - Street 1:160 N RIDGEWAY DR STE 107
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4113
Practice Address - Country:US
Practice Address - Phone:817-487-5966
Practice Address - Fax:817-556-0394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty