Provider Demographics
NPI:1093940678
Name:ELDERLY AND DISABLED SERVICES, LLC
Entity Type:Organization
Organization Name:ELDERLY AND DISABLED SERVICES, LLC
Other - Org Name:RIDGE AVENUE ELDERCARE SERVCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-784-3217
Mailing Address - Street 1:2653 W GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-5258
Mailing Address - Country:US
Mailing Address - Phone:215-684-2464
Mailing Address - Fax:215-684-2551
Practice Address - Street 1:2653 W GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-5258
Practice Address - Country:US
Practice Address - Phone:215-684-2464
Practice Address - Fax:215-684-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
PA314294261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No253Z00000XAgenciesIn Home Supportive Care