Senior Life Home Care, Inc

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

HC3612 Issued in NC

Legal business name

SENIOR LIFE HOME CARE, INC

Practice address

4030 Wake Forest Rd Ste 300
Raleigh, NC 27609-6800

Phone

(919) 462-7003

Fax

(919) 655-1592

NPI assigned

Mar 22, 2017

Organization subpart

No

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

Authorized official

Name

Kelly Reeves

Title

Agency Director

Phone

(919) 462-7003

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1490140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613520000000",
    "number": "1609307545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 508",
            "city": "ROLESVILLE",
            "state": "NC",
            "postal_code": "275710508",
            "telephone_number": "919-462-7003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4030 WAKE FOREST RD STE 300",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096800",
            "telephone_number": "919-462-7003",
            "fax_number": "919-655-1592"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8396 Six Forks Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276153058",
            "country_code": "US",
            "telephone_number": "919-462-7003",
            "fax_number": "919-655-1592",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SENIOR LIFE HOME CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-22",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A",
        "authorized_official_last_name": "REEVES",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "AGENCY DIRECTOR",
        "authorized_official_telephone_number": "919-462-7003"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NC",
            "license": "HC3612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; 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.