MEDICARE: ELDER HOME CARE, LLC.

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	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1275166704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELDER HOME CARE, LLC.

Provider Business Mailing Address
First Line	:	1735 MARKET ST # 308
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-7501
Country	:	US
Telephone Number	:	917-699-7442
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 MARKET ST # 308
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-7501
Country	:	US
Telephone Number	:	917-699-7442
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MATTHEW RUSSO
Credential	:
Telephone Number	:	917-699-7442

Provider Enumeration Date	:	02/12/2020
Last Update Date	:	02/12/2020

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