Provider Demographics
NPI:1427094812
Name:SENIOR FRIEND ASSOCIATES, INC.
Entity type:Organization
Organization Name:SENIOR FRIEND ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIENZLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:218-727-1111
Mailing Address - Street 1:301 W. 1ST STREET
Mailing Address - Street 2:SUITE 309
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1636
Mailing Address - Country:US
Mailing Address - Phone:218-727-1111
Mailing Address - Fax:218-720-6819
Practice Address - Street 1:301 W. 1ST STREET
Practice Address - Street 2:SUITE 309
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1636
Practice Address - Country:US
Practice Address - Phone:218-727-1111
Practice Address - Fax:218-720-6819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330710251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN120013OtherBLUE FIRSTPLAN
MN8399SEOtherBLUE CROSS BS
MN110199OtherUCARE
MN373355600Medicaid
MN5900091OtherMEDICA
MN7280023OtherMEDICA
247227Medicare Oscar/Certification