Healthcare Provider Details

I. General information

NPI: 1730157264
Provider Name (Legal Business Name): ELDERLY UNITED OF SPRINGFIELD & CLARK COUNTY OHIO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S FOUNTAIN AVE
SPRINGFIELD OH
45502-1207
US

IV. Provider business mailing address

125 W MAIN ST
SPRINGFIELD OH
45502-1311
US

V. Phone/Fax

Practice location:
  • Phone: 937-323-4948
  • Fax: 937-324-9005
Mailing address:
  • Phone: 937-323-4948
  • Fax: 937-324-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number0424
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MS. MAUREEN FAGANS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 937-323-4948