Healthcare Provider Details

I. General information

NPI: 1275356255
Provider Name (Legal Business Name): ELIDEN HEALTHCARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 GORDON HOUSE WAY
MIDDLETOWN DE
19709-9975
US

IV. Provider business mailing address

674 GORDON HOUSE WAY
MIDDLETOWN DE
19709-9975
US

V. Phone/Fax

Practice location:
  • Phone: 215-910-9003
  • Fax:
Mailing address:
  • Phone: 215-910-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA DENNIS
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 215-910-9003