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General NPI Number Information
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NPI Number | 1114835311
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Entity Type | Organization
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Legal Business Name | MEDIORA ELEVUS DIVERSIFIED
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Dates
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Enumeration Date | 08/29/2026
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Last Update Date | 08/29/2026
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Provider Practice Location Address
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Address Line | 388 CANTERBURY RD
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City | BUSHKILL
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State | PA
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Zip | 18324-9055
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Country | US
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Telephone | 215-933-2562
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Fax |
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Provider Business Mailing Address
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Address Line | 30 S 15TH ST STE 1550
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4806
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Country | US
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Telephone | 215-933-2562
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RASHIDAH JACKSON
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Credential | LPN
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Telephone | 856-676-1946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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