Healthcare Provider Details

I. General information

NPI: 1205044765
Provider Name (Legal Business Name): ELDER AIDE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 02/12/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 2ND AVE
CHARLESTON WV
25387-2514
US

IV. Provider business mailing address

PO BOX 20112
CHARLESTON WV
25362-1112
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-0586
  • Fax: 304-344-0587
Mailing address:
  • Phone: 304-344-0586
  • Fax: 304-344-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC ALLEN HICKS
Title or Position: OWNER
Credential:
Phone: 304-344-0586