Healthcare Provider Details

I. General information

NPI: 1699292367
Provider Name (Legal Business Name): ELDER PATH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 E CLAIBORNE SQ. STE 334
HAMPTON VA
22366-2200
US

IV. Provider business mailing address

4410 E CLAIBORNE SQ. STE 334
HAMPTON VA
23666-2200
US

V. Phone/Fax

Practice location:
  • Phone: 757-251-3838
  • Fax: 757-282-5857
Mailing address:
  • Phone: 757-251-3838
  • Fax: 757-282-5857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MS. SHERVONNE EVETTE BANKS
Title or Position: GERONTOLOGIST
Credential: MSG
Phone: 757-240-7928