NPIMap

Organization Active NPI

Senior Source, LLC

  • Home Health Agency
  • Saint Louis, MO
National Provider Identifier
1801447016
Registry record updated Sep 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
SENIOR SOURCE, LLC
Practice address
1521 Fathom Dr
Saint Louis, MO 63137-1549
Phone
(314) 278-8006
NPI assigned
Sep 28, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2019

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

Authorized official

Name
Shamikka Carlson
Title
Executive Owner
Phone
(314) 278-8006

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

1521 Fathom Dr
Saint Louis, MO 63137-1549

Mailing address

1521 Fathom Dr
Saint Louis, MO 63137-1549
Phone (314) 278-8006

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1569628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569628800000",
    "number": "1801447016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1521 FATHOM DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631371549",
            "telephone_number": "314-278-8006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 FATHOM DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631371549",
            "telephone_number": "314-278-8006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR SOURCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-28",
        "last_updated": "2019-09-28",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "SHAMIKKA",
        "authorized_official_title_or_position": "EXECUTIVE OWNER",
        "authorized_official_telephone_number": "314-278-8006"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2019; 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.