Seniors Care Services LLC
Organization Active NPI Adult Health Nurse Practitioner · Spring Park, MN
NPI 1467865634 · NPPES record last updated Jan 28, 2021
Key facts
- NPI
- 1467865634
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adult Health Nurse Practitioner 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
- Organization subpart
- No
Authorized official
- Name
- Mr. Damon R Kenton, PHD
- Title
- Ceo
- Phone
- (612) 242-9517
Practitioners 5
-
Ajit N Chary, M.D.
-
Edward M Friedler, M.D.
-
Zaid Fadul, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in DC, MD, NC, AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
4008 Shoreline Dr
Spring Park, MN 55384
Phone (952) 923-1028
209 S Livingston Ave
Ste 7
Livingston, NJ 07039
Phone (973) 535-2734
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner |
363LA2200X | Yes |
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
- Population Health Management, LLC
- Tonka Medical Association, LLC
Other providers in Spring Park, MN
- Ridgeview Clinics
- Ridgeview Medical Center
- Jennifer H Rysso
- Sheila N Seats
- Senior Care of Minnesota
- SP Services
- SP Services
- Thomas G Stocks
- TCM Wellness Clinic
- Kelly Jean Tibbetts
All providers in Spring Park, MN · Adult Health Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.