Provider Demographics
NPI:1003082975
Name:ELDERCARE FOR LIFE
Entity Type:Organization
Organization Name:ELDERCARE FOR LIFE
Other - Org Name:THOROUGHCARE REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDIVORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-803-1234
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-0429
Mailing Address - Country:US
Mailing Address - Phone:520-803-1234
Mailing Address - Fax:520-803-6552
Practice Address - Street 1:6164 S HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615-9283
Practice Address - Country:US
Practice Address - Phone:520-803-1234
Practice Address - Fax:520-803-6552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation