Provider Demographics
NPI:1699057604
Name:SENIOR HOUSE MANAGEMENT
Entity type:Organization
Organization Name:SENIOR HOUSE MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAVA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:423-256-0002
Mailing Address - Street 1:600 STRICKLAND CT
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-0434
Mailing Address - Country:US
Mailing Address - Phone:423-256-0002
Mailing Address - Fax:423-357-4242
Practice Address - Street 1:600 STRICKLAND CT
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-0434
Practice Address - Country:US
Practice Address - Phone:423-256-0002
Practice Address - Fax:423-357-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACL0000000239310400000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445829Medicaid