Healthcare Provider Details

I. General information

NPI: 1427946300
Provider Name (Legal Business Name): ELDER CARE PLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28245 KING RD
ROMULUS MI
48174-9446
US

IV. Provider business mailing address

28245 KING RD
ROMULUS MI
48174-9446
US

V. Phone/Fax

Practice location:
  • Phone: 248-688-4616
  • Fax:
Mailing address:
  • Phone: 248-688-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: RODICA TIMOFICIUC
Title or Position: OWNER
Credential:
Phone: 248-688-4616