Provider Demographics
NPI:1427674373
Name:LEE SENIOR SERVICES, LLC
Entity type:Organization
Organization Name:LEE SENIOR SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHRUCHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-489-0023
Mailing Address - Street 1:9800 S HEALTHPARK DR STE 350
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3630
Mailing Address - Country:US
Mailing Address - Phone:239-489-0023
Mailing Address - Fax:
Practice Address - Street 1:16451 HEALTHPARK COMMONS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9501
Practice Address - Country:US
Practice Address - Phone:239-489-0023
Practice Address - Fax:239-204-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty