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General NPI Number Information
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NPI Number | 1861916462
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Entity Type | Organization
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Legal Business Name | ELDER HOME CARE LLC
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Dates
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Enumeration Date | 07/26/2017
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 51A CRESCENT RD
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-3328
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Country | US
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Telephone | 19176997442
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Fax |
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Provider Business Mailing Address
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Address Line | 51A CRESCENT RD
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-3328
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Country | US
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Telephone | 19176997442
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MATTHEW RUSSO
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Credential |
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Telephone | 917-699-7442
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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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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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