Healthcare Provider Details

I. General information

NPI: 1093940678
Provider Name (Legal Business Name): ELDERLY AND DISABLED SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2653 W GLENWOOD AVE
PHILADELPHIA PA
19121-5258
US

IV. Provider business mailing address

2653 W GLENWOOD AVE
PHILADELPHIA PA
19121-5258
US

V. Phone/Fax

Practice location:
  • Phone: 215-684-2464
  • Fax: 215-684-2551
Mailing address:
  • Phone: 215-684-2464
  • Fax: 215-684-2551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number314294
License Number StatePA

VIII. Authorized Official

Name: MS. LINDA STALEY
Title or Position: BOARD MEMBER
Credential:
Phone: 267-784-3217