Healthcare Provider Details

I. General information

NPI: 1447845763
Provider Name (Legal Business Name): ELDERLY AND DISABLED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4439 HAMRICK RD
CENTRAL POINT OR
97502-2816
US

IV. Provider business mailing address

3126 STATE ST STE 100
MEDFORD OR
97504-8665
US

V. Phone/Fax

Practice location:
  • Phone: 541-261-1991
  • Fax: 541-631-3424
Mailing address:
  • Phone: 458-225-9358
  • Fax: 541-631-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LARRY MICHAEL MCPHEE
Title or Position: PROVIDER
Credential:
Phone: 541-261-1991