Healthcare Provider Details

I. General information

NPI: 1114422862
Provider Name (Legal Business Name): ELDERLY HEALTHCARE CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 DECATUR LN
SICKLERVILLE NJ
08081-2806
US

IV. Provider business mailing address

PO BOX 685
SICKLERVILLE NJ
08081-0685
US

V. Phone/Fax

Practice location:
  • Phone: 856-986-4582
  • Fax:
Mailing address:
  • Phone: 856-986-4582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNJ

VIII. Authorized Official

Name: MAKEESA Y JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 856-986-4582