MEDICARE: ELDERLY ELEGANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1225821614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELDERLY ELEGANCE

Provider Business Mailing Address
First Line	:	2319 HARRISON ST
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-3140
Country	:	US
Telephone Number	:	270-331-1044
Fax Number	:

Provider Business Practice Location Address
First Line	:	2319 HARRISON ST
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-3140
Country	:	US
Telephone Number	:	270-331-1044
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHARONDA MASON
Credential	:	BHS
Telephone Number	:	270-331-1044

Provider Enumeration Date	:	05/28/2025
Last Update Date	:	03/17/2026

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Directions to “ELDERLY ELEGANCE ” Practice Location

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