=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710103676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELDER AIDE SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 08/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 513 CENTRAL AVE.
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-344-0586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 513 CENTRAL AVENUE
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25302-2811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-344-0586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. ERIC ALLEN HICKS I
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-344-0586
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------