1053367094 NPI number — ELDER CARE, INC.

Table of content: (NPI 1053367094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053367094 NPI number — ELDER CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELDER CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELDER CARE HOME HEALTH SERVICES, INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053367094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3318 MILLBRANCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38116-3624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-398-2167
Provider Business Mailing Address Fax Number:
901-398-9337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3318 MILLBRANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38116-3624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-398-2167
Provider Business Practice Location Address Fax Number:
901-398-9337
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PERKINS
Authorized Official First Name:
ROSETTA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
901-398-2167

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  0000000224 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: PSS0000000021 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0447525 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 197044 . This is a "GENTIVA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 53755 . This is a "OMNICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 53953 . This is a "TN CARE SELECT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 33ELDCAR220001 . This is a "INFUSION PARTNERS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1078980 . This is a "ACM-UNITED HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 21059 . This is a "TLC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 53953 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 447525 . This is a "PHARMATHERA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 117212 . This is a "BETTER HEALTH PLAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 447525 . This is a "AHCA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: V0000909120 . This is a "T.E.I.S." identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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