Provider Demographics
NPI:1326375882
Name:SENIORS ON THE GO
Entity type:Organization
Organization Name:SENIORS ON THE GO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-396-1998
Mailing Address - Street 1:14306 LEMOYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-9760
Mailing Address - Country:US
Mailing Address - Phone:228-254-0370
Mailing Address - Fax:228-396-2907
Practice Address - Street 1:14306 LEMOYNE BLVD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-9760
Practice Address - Country:US
Practice Address - Phone:228-254-0370
Practice Address - Fax:228-396-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS310400000X310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility