Healthcare Provider Details

I. General information

NPI: 1629343900
Provider Name (Legal Business Name): ELDER ASSISTANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 MISSOURI AVE
NEW PORT RICHEY FL
34652-2650
US

IV. Provider business mailing address

5623 US HIGHWAY 19 SUITE 201
NEW PORT RICHEY FL
34652-3700
US

V. Phone/Fax

Practice location:
  • Phone: 727-326-4432
  • Fax:
Mailing address:
  • Phone: 727-326-4432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number230919
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number9179
License Number StateFL

VIII. Authorized Official

Name: KATHLEEN MENGLE
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 727-326-4432