=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982886784
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELDERSERVE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2007
-----------------------------------------------------
Last Update Date | 12/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 E MUHAMMAD ALI BLVD
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-1501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-587-8673
-----------------------------------------------------
Fax | 502-583-8057
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 E MUHAMMAD ALI BLVD
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-1501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-587-8673
-----------------------------------------------------
Fax | 502-583-8057
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF IN-HOME SERVICES
-----------------------------------------------------
Name | MS. JOANNE LANIER WHITLOCK
-----------------------------------------------------
Credential | MSSW
-----------------------------------------------------
Telephone | 502-583-8012
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 0
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------