Healthcare Provider Details

I. General information

NPI: 1932333481
Provider Name (Legal Business Name): ELDERLY CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11892 FERNDALE ST
PHILADELPHIA PA
19116-2008
US

IV. Provider business mailing address

11892 FERNDALE ST
PHILADELPHIA PA
19116-2008
US

V. Phone/Fax

Practice location:
  • Phone: 917-991-4869
  • Fax:
Mailing address:
  • Phone: 917-991-4869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL VOLLER
Title or Position: MEMBER
Credential:
Phone: 917-991-4869