Healthcare Provider Details

I. General information

NPI: 1770147647
Provider Name (Legal Business Name): AELITE SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 N DELAWARE DR
NYACK NY
10960-2309
US

IV. Provider business mailing address

7 N DELAWARE DR
NYACK NY
10960-2309
US

V. Phone/Fax

Practice location:
  • Phone: 845-494-2083
  • Fax:
Mailing address:
  • Phone: 845-494-2083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: HAZEL M LAROCHELLE
Title or Position: PRESIDENT
Credential:
Phone: 845-494-2083