NPIMap

Organization Active NPI

Seniors Care Services LLC

  • Adult Health Nurse Practitioner
  • Spring Park, MN
National Provider Identifier
1467865634
Registry record updated Oct 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
Legal business name
SENIORS CARE SERVICES LLC
Practice address
4142 Shoreline Dr
Spring Park, MN 55384-9629
Phone
(800) 753-9972
NPI assigned
Jun 5, 2014
Last updated
Oct 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2026

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

Authorized official

Name
Mr. Damon R Kenton, PHD
Title
Ceo
Phone
(866) 305-0622

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LA2200X Primary

Addresses

Primary practice location

4142 Shoreline Dr
Spring Park, MN 55384-9629

Mailing address

4008 Shoreline Dr
Spring Park, MN 55384-9656
Phone (612) 242-9517

Other names 2

  • Population Health Management, LLC Former legal business name
  • Tonka Medical Association, LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD, NC, AZ4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20170718002395 DC Part B Supplier - Clinic/Group Practice 0446520860 Receives reassigned benefits from 2 practitioners
Practice locations: Annandale, VA; Gaithersburg, MD; Largo, MD
O20170718002906 MD Part B Supplier - Clinic/Group Practice 0446520860 Receives reassigned benefits from 1 practitioner
Practice locations: Havre de Grace, MD
O20170911001442 NC Part B Supplier - Clinic/Group Practice 0446520860 Receives reassigned benefits from 2 practitioners
Practice locations: Greensboro, NC
O20171115001951 AZ Part B Supplier - Clinic/Group Practice 0446520860 Receives reassigned benefits from 1 practitioner
Practice locations: Phoenix, AZ

National Provider Directory

National Provider Directory

Locations

1208 E Churchville Rd
Ste 200
Bel Air, MD 21014
Phone (410) 399-9911

805 S Union Ave
Hvre de Grace, MD 21078
Phone (410) 939-5843

4008 Shoreline Dr
Spring Park, MN 55384
Phone (952) 923-1028

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1401926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791590400000",
    "number": "1467865634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4008 SHORELINE DR",
            "city": "SPRING PARK",
            "state": "MN",
            "postal_code": "553849656",
            "telephone_number": "612-242-9517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4142 SHORELINE DR",
            "city": "SPRING PARK",
            "state": "MN",
            "postal_code": "553849629",
            "telephone_number": "800-753-9972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIORS CARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-05",
        "last_updated": "2026-10-10",
        "certification_date": "2026-10-10",
        "status": "A",
        "authorized_official_last_name": "KENTON",
        "authorized_official_first_name": "DAMON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "866-305-0622",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Population Health Management, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Tonka Medical Association, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Tonka Medical Association, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Spring Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.