Provider Demographics
NPI:1427271352
Name:SENIOR CONNECT
Entity type:Organization
Organization Name:SENIOR CONNECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF AGING SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-563-1422
Mailing Address - Street 1:P. O. BOX 836
Mailing Address - Street 2:200 SOUTH VIRGINIA STREET
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-3716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-3716
Practice Address - Country:US
Practice Address - Phone:972-563-1422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001000882332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001000882OtherMEALS ON WHEELS