Provider Demographics
NPI:1417596149
Name:SEED OF LIFE SENIOR CARE LLC
Entity type:Organization
Organization Name:SEED OF LIFE SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:571-282-8107
Mailing Address - Street 1:7709 YALTA WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-1983
Mailing Address - Country:US
Mailing Address - Phone:703-232-1424
Mailing Address - Fax:
Practice Address - Street 1:7709 YALTA WAY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-1983
Practice Address - Country:US
Practice Address - Phone:703-232-1424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care