Healthcare Provider Details

I. General information

NPI: 1114763349
Provider Name (Legal Business Name): ELDERFLOWER ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1611 CHARLOTTE HWY
FAIRVIEW NC
28730-9561
US

IV. Provider business mailing address

1611 CHARLOTTE HWY
FAIRVIEW NC
28730-9561
US

V. Phone/Fax

Practice location:
  • Phone: 708-691-3253
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENEE PANTER
Title or Position: HEAD NURSE
Credential: RN
Phone: 504-427-9329