=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417918541
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN ELDERCARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2006
-----------------------------------------------------
Last Update Date | 04/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3320 NW 53RD ST SUITE 203
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33309-6324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-734-1476
-----------------------------------------------------
Fax | 561-495-0519
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3320 NW 53RD ST SUITE 203
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33309-6324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-734-1476
-----------------------------------------------------
Fax | 561-495-0519
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. OWEPATRICE GAILLARD
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 561-558-7008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HHA299992115
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------