Healthcare Provider Details

I. General information

NPI: 1558745901
Provider Name (Legal Business Name): ELDER CARE DAY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1774 COPE AVE.
MAPLEWOOD MN
55109
US

IV. Provider business mailing address

1774 COPE AVE.
MAPLEWOOD MN
55109
US

V. Phone/Fax

Practice location:
  • Phone: 651-734-3913
  • Fax: 651-440-9118
Mailing address:
  • Phone: 651-734-3913
  • Fax: 651-440-9118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1076075
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number1076075
License Number StateMN

VIII. Authorized Official

Name: SOUK HER
Title or Position: OWNER / CENTER COORDINATOR
Credential:
Phone: 651-734-3913