Provider Demographics
NPI:1083143374
Name:ECKELBERRY'S ELDERLY CARE, INC
Entity Type:Organization
Organization Name:ECKELBERRY'S ELDERLY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:CLARKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:641-210-5756
Mailing Address - Street 1:500 WILLOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8320
Mailing Address - Country:US
Mailing Address - Phone:972-347-3069
Mailing Address - Fax:866-278-8020
Practice Address - Street 1:500 WILLOWVIEW DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8320
Practice Address - Country:US
Practice Address - Phone:972-347-3069
Practice Address - Fax:866-278-8020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137829310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility