Provider Demographics
NPI:1366602534
Name:SENIOR CARE MANAGEMENT INC
Entity type:Organization
Organization Name:SENIOR CARE MANAGEMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-303-9000
Mailing Address - Street 1:1413 E INTERSTATE 30 STE 7
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-4598
Mailing Address - Country:US
Mailing Address - Phone:972-303-9000
Mailing Address - Fax:972-303-9992
Practice Address - Street 1:105 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:TX
Practice Address - Zip Code:75479
Practice Address - Country:US
Practice Address - Phone:903-965-0200
Practice Address - Fax:972-303-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118311385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001003216Medicaid