Healthcare Provider Details

I. General information

NPI: 1649974601
Provider Name (Legal Business Name): ELDEREDGE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4383 CARPENTER AVE
BRONX NY
10466-1346
US

IV. Provider business mailing address

4383 CARPENTER AVE
BRONX NY
10466-1346
US

V. Phone/Fax

Practice location:
  • Phone: 561-957-3712
  • Fax:
Mailing address:
  • Phone: 561-957-3712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: KALIA HARRIS
Title or Position: CEO
Credential:
Phone: 561-957-3712