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General NPI Number Information
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NPI Number | 1003965880
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Entity Type | Organization
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Legal Business Name | ELDERHEALTH & LIVING, CORPORATION
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 382 S 58TH ST STE B
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City | SPRINGFIELD
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State | OR
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Zip | 97478-7623
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Country | US
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Telephone | 541-747-4858
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Fax | 541-747-5322
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Provider Business Mailing Address
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Address Line | 382 S 58TH ST STE B
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City | SPRINGFIELD
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State | OR
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Zip | 97478-7623
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Country | US
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Telephone | 541-747-4858
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Fax | 541-747-5322
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Authorized Official
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Title or Position | MEDICAL DIRECTOR CEO
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Name | ELIZABETH PORTER VON WELLSHEIM
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Credential | GNP
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Telephone | 541-747-4858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 1748265563
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License Number State | OR
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