Healthcare Provider Details

I. General information

NPI: 1255228664
Provider Name (Legal Business Name): ELDERS LOUNGE ADULT HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 KELLY RD
SOUTH WINDSOR CT
06074-3118
US

IV. Provider business mailing address

20 KELLY RD
SOUTH WINDSOR CT
06074-3118
US

V. Phone/Fax

Practice location:
  • Phone: 860-430-0377
  • Fax: 860-345-6427
Mailing address:
  • Phone: 860-430-0377
  • Fax: 860-345-6427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. AMANDA O KWARTENG
Title or Position: OWNER/DIRECTOR
Credential: LPN, MBA, LNHA
Phone: 860-430-0377