Healthcare Provider Details

I. General information

NPI: 1699983312
Provider Name (Legal Business Name): ELDERHAUS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S 17TH ST
WILMINGTON NC
28401-7515
US

IV. Provider business mailing address

2222 S 17TH ST
WILMINGTON NC
28401-7515
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-8209
  • Fax: 910-343-8836
Mailing address:
  • Phone: 910-343-8209
  • Fax: 910-343-8836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: RUTH FINCH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 910-343-8209