Provider Demographics
NPI:1194023721
Name:ELDERLYCARE MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:ELDERLYCARE MEDICAL EQUIPMENT
Other - Org Name:ELDERLYCARE MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:NWACHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-220-2977
Mailing Address - Street 1:1515 ALCONBURY RD APT F
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-4025
Mailing Address - Country:US
Mailing Address - Phone:443-220-2977
Mailing Address - Fax:
Practice Address - Street 1:1515F ALCONBURY ROAD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221
Practice Address - Country:US
Practice Address - Phone:443-220-2977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELDERYCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2967332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies