Organization
SENIOR SOURCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAMIKKA CARLSON (EXECUTIVE OWNER)
(314) 278-8006
Entity
Organization
Contact information
Practice address
1521 FATHOM DR, SAINT LOUIS, MO 63137-1549
(314) 278-8006
Mailing address
1521 FATHOM DR, SAINT LOUIS, MO 63137-1549
(314) 278-8006
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
09/28/2019
Last updated
09/28/2019
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