=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407265309
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELDER DAY CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2014
-----------------------------------------------------
Last Update Date | 08/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 757 W MAIN ST
-----------------------------------------------------
City | EL CENTRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92243-2921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-337-8393
-----------------------------------------------------
Fax | 760-337-8449
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 643 MAIN ST
-----------------------------------------------------
City | BRAWLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92227-2547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-344-4654
-----------------------------------------------------
Fax | 760-344-4608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ELIZABETH TOSTE MACHADO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-996-7913
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------