=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023994696
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIDEN HEALTHCARE AGENCY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2025
-----------------------------------------------------
Last Update Date | 08/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 241 BERKLEY AVE
-----------------------------------------------------
City | LANSDOWNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19050-1354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-910-9003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 241 BERKLEY AVE
-----------------------------------------------------
City | LANSDOWNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19050-1354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-910-9003
-----------------------------------------------------
Fax | 215-910-9003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROPRIETOR
-----------------------------------------------------
Name | VIRGINIA K. DENNIS
-----------------------------------------------------
Credential | CRNP, DNP
-----------------------------------------------------
Telephone | 215-910-9003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------