Healthcare Provider Details

I. General information

NPI: 1982686093
Provider Name (Legal Business Name): ELDERCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 N 17TH ST
BELLEVILLE IL
62226-6552
US

IV. Provider business mailing address

2810 FRANK SCOTT PKWY W SUITE 820
BELLEVILLE IL
62223-5007
US

V. Phone/Fax

Practice location:
  • Phone: 618-234-3323
  • Fax: 618-234-9477
Mailing address:
  • Phone: 618-234-2273
  • Fax: 618-234-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0023309
License Number StateIL

VIII. Authorized Official

Name: MR. STEVEN C WOLF
Title or Position: PRESIDENT
Credential:
Phone: 618-234-2273