Provider Demographics
NPI:1487713384
Name:MID COUNTY SENIOR SERVICES
Entity type:Organization
Organization Name:MID COUNTY SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULIMAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-353-6642
Mailing Address - Street 1:22 MEDIA LINE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4601
Mailing Address - Country:US
Mailing Address - Phone:610-353-6642
Mailing Address - Fax:610-353-7950
Practice Address - Street 1:1500 GARRETT RD
Practice Address - Street 2:BARCLAY SQUARE ADULT DAY SERVICES
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-4519
Practice Address - Country:US
Practice Address - Phone:610-626-0662
Practice Address - Fax:610-626-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA301430261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000058970002Medicaid
PA1000058970006Medicaid