SENIOR LIFE LLC (NPI# 1194140509) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194140509 |
| Entity Type | Organization |
| Organization Name | SENIOR LIFE LLC |
| Practice Address |
619 Orange Ave Daytona Beach FL 32114-4786 |
| Mailing Address |
Po Box 48857 Tampa FL 33646-0124 |
| Practice Telephone | 8133190961 |
| Mailing Telephone | 8133190961 |
| Enumeration Date | 2014-02-20 |
| Last Update Date | 2014-02-20 |
| Authorized Official Name | MR. CHARLES W CHERRY II (SENIOR ADMINISTRATOR) |
| Authorized Official Telephone | 8132677342 |
| Authorized Official Credential | J.D., M.B.A. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | FL | Nursing & Custodial Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427402163 | Senior Life LLC | In Home Supportive Care | 109 Belva Dr, Vicksburg, MS 39180-8928 | 2016-04-19 |
| Street Address |
619 ORANGE AVE |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32114-4786 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376161380 | Evolution Health & Performance LLC | Physician Assistant | 244 S. Palmetto Ave, Daytona Beach, FL 32114 | 2020-07-07 |
| 1407480189 | Kierra Imani Kinsey | Behavior Technician | 1128-a Beville Rd, Daytona Beach, FL 32114 | 2020-03-02 |
| 1043776057 | Outreach Community Care Network Inc | Pharmacy | 240 N. Frederick Avenue, Daytona Beach, FL 32114 | 2019-02-14 |
| 1033681861 | Katherine Proppe | Specialist/Technologist | 1 Aerospace Blvd, Daytona Beach, FL 32114 | 2018-12-18 |
| 1841765047 | Anna L Smith | Nurse Practitioner | 339 Bill France Blvd Ste C, Daytona Beach, FL 32114 | 2018-10-04 |
| 1154806933 | Steve Anthony Lee | Family Medicine | 731 N. Clyde Morris Blvd, Daytona Beach, FL 32114 | 2018-09-27 |
| 1285116491 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1348 W International Speedway Blvd Ste 2, Daytona Beach, FL 32114 | 2018-09-04 |
| 1770085656 | Merina Lee | Occupational Therapist | 1159 Australia Ave., Daytona Beach, FL 32114 | 2018-03-06 |
| 1346752755 | Hand & Upper Extremity Surgery of Daytona Beach, LLC | Non-Pharmacy Dispensing Site | 1241 Ridgewood Ave, Daytona Beach, FL 32114 | 2017-10-26 |
| 1104347053 | Harry Herman Blanke IIi | Family Medicine | 201 N Clyde Morris Blvd, Suite 200, Halifax Health Family Medicine Residency Program, Daytona Beach, FL 32114 | 2017-06-30 |
| Find all providers in zip 32114 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104436443 | Baywood Meadows Assisted Living | Assisted Living Facility | 105 Baywood Dr, Daytona Beach, FL 32117-4601 | 2020-08-02 |
| 1912323056 | Editha Ignacio | Assisted Living Facility | 1636 E Shangri La Dr, Daytona Beach, FL 32119-1520 | 2014-03-13 |
| 1275957276 | Isabelle Berber | Assisted Living Facility | 1249 Suwanee Rd, Daytona Beach, FL 32114-5918 | 2014-02-11 |
| 1942624366 | Justina Threadgill | Assisted Living Facility | 1312 Mardrake Rd, Daytona Beach, FL 32114-5940 | 2014-02-05 |
| 1912337866 | Compassion In Healthcare Inc | Assisted Living Facility | 700 Beville Rd, Daytona Beach, FL 32114-5924 | 2013-11-13 |
| 1013345883 | Kist Alf, Inc | Assisted Living Facility | 1516 Carmen Avenue, Daytona Beach, FL 32117 | 2013-10-14 |
| 1306180724 | Lakewood Park Investments Inc | Assisted Living Facility | 1220 Jimmy Ann Dr, Daytona Beach, FL 32117-3818 | 2012-11-26 |
| 1316281215 | Selah - Forest Lake Manor, LLC | Assisted Living Facility | 252 Forest Lake Blvd, Daytona Beach, FL 32119-8106 | 2012-11-15 |
| 1699036285 | Shady Oaks Rest Home Inc. | Assisted Living Facility | 1208 Kennedy Rd, Daytona Beach, FL 32117 | 2012-05-31 |
| 1437266350 | The Place At Daytona Beach, Inc. | Assisted Living Facility | 570 National Health Care Dr, Daytona Beach, FL 32114-1494 | 2006-08-24 |
| Find all providers in DAYTONA BEACH | ||||
| City | DAYTONA BEACH |
| Zip Code | 32114 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.