Senior Life LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

P320988 Issued in MS

Legal business name

SENIOR LIFE LLC

Practice address

109 Belva Dr
Vicksburg, MS 39180-8928

Phone

(769) 203-1773

NPI assigned

Apr 19, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Shenicia Sorrels

Title

Owner

Phone

(769) 203-1773

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461024000000",
    "number": "1427402163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 BELVA DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391808928",
            "telephone_number": "769-203-1773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 BELVA DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391808928",
            "telephone_number": "769-203-1773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR LIFE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-19",
        "last_updated": "2016-04-19",
        "status": "A",
        "authorized_official_last_name": "SORRELS",
        "authorized_official_first_name": "SHENICIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "769-203-1773",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "MS",
            "license": "P320988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• In Home Supportive Care Agency in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• In Home Supportive Care Agency in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.