Provider Demographics
NPI:1538405204
Name:SENIOR CARE OF EVANSVILLE, LLC
Entity type:Organization
Organization Name:SENIOR CARE OF EVANSVILLE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEVI
Authorized Official - Middle Name:A
Authorized Official - Last Name:REAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-685-5045
Mailing Address - Street 1:18 NW 4TH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1700
Mailing Address - Country:US
Mailing Address - Phone:812-402-5970
Mailing Address - Fax:812-402-5973
Practice Address - Street 1:18 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1778
Practice Address - Country:US
Practice Address - Phone:812-402-5970
Practice Address - Fax:812-402-5973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12-012859-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health