Healthcare Provider Details

I. General information

NPI: 1184073058
Provider Name (Legal Business Name): ELMWOOD HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 DUDLEY STREET SUITE 201
PROVIDENCE RI
02905
US

IV. Provider business mailing address

120 DUDLEY STREET SUITE 201
PROVIDENCE RI
02905
US

V. Phone/Fax

Practice location:
  • Phone: 401-941-1347
  • Fax: 401-941-0823
Mailing address:
  • Phone: 401-941-1347
  • Fax: 401-941-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateRI

VIII. Authorized Official

Name: IGOR YATSKAR
Title or Position: PRESIDENT
Credential:
Phone: 401-941-1347