Healthcare Provider Details

I. General information

NPI: 1326862277
Provider Name (Legal Business Name): ELDER EMPOWERMENT FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 MOUNT VERNON CIR
VACAVILLE CA
95688-9405
US

IV. Provider business mailing address

3220 BLUME DR STE 100
SAN PABLO CA
94806-1903
US

V. Phone/Fax

Practice location:
  • Phone: 707-408-2162
  • Fax:
Mailing address:
  • Phone: 415-275-0839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PIERRE-ANDRE M MALBROUGH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 510-798-7209