Provider Demographics
NPI:1417257965
Name:SPECIAL SENIORS OF INVERRARY INC.
Entity type:Organization
Organization Name:SPECIAL SENIORS OF INVERRARY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:LEONICA
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-746-8550
Mailing Address - Street 1:7471 NW 35TH CT
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4919
Mailing Address - Country:US
Mailing Address - Phone:954-746-8550
Mailing Address - Fax:954-572-8096
Practice Address - Street 1:7471 NW 35TH CT
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4919
Practice Address - Country:US
Practice Address - Phone:954-746-8550
Practice Address - Fax:954-572-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10239261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL141546800Medicaid