Provider Demographics
NPI:1245891761
Name:THE LIVING ROOM - SENIOR SERVICES
Entity type:Organization
Organization Name:THE LIVING ROOM - SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRADDUCK
Authorized Official - Suffix:
Authorized Official - Credentials:BA - GERONTOLOGY
Authorized Official - Phone:760-983-5909
Mailing Address - Street 1:9828 VALLE VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92371-8431
Mailing Address - Country:US
Mailing Address - Phone:760-983-5909
Mailing Address - Fax:
Practice Address - Street 1:9828 VALLE VISTA RD
Practice Address - Street 2:
Practice Address - City:PHELAN
Practice Address - State:CA
Practice Address - Zip Code:92371-8431
Practice Address - Country:US
Practice Address - Phone:760-983-5909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care