Healthcare Provider Details

I. General information

NPI: 1922424027
Provider Name (Legal Business Name): ELEANOR'S GARDEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10125 VERREE RD SUIT 202
PHILADELPHIA PA
19116-3611
US

IV. Provider business mailing address

10125 VERREE RD SUITE 202
PHILADELPHIA PA
19116-3611
US

V. Phone/Fax

Practice location:
  • Phone: 215-302-2003
  • Fax: 215-941-7304
Mailing address:
  • Phone: 215-302-2003
  • Fax: 215-941-7304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number17701601
License Number StatePA

VIII. Authorized Official

Name: BARBARA G ROSSI
Title or Position: COO
Credential: RN
Phone: 215-302-2003