Provider Demographics
NPI:1386392421
Name:SENIOR PERSONAL CARE SOLUTIONS LLC
Entity type:Organization
Organization Name:SENIOR PERSONAL CARE SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-262-6552
Mailing Address - Street 1:535 EMERALD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-5069
Mailing Address - Country:US
Mailing Address - Phone:770-262-6552
Mailing Address - Fax:
Practice Address - Street 1:535 EMERALD LAKE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-5069
Practice Address - Country:US
Practice Address - Phone:770-262-6552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health