Provider Demographics
NPI:1417918541
Name:AMERICAN ELDERCARE, INC
Entity Type:Organization
Organization Name:AMERICAN ELDERCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OWEPATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-558-7008
Mailing Address - Street 1:3320 NW 53RD ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6324
Mailing Address - Country:US
Mailing Address - Phone:954-734-1476
Mailing Address - Fax:561-495-0519
Practice Address - Street 1:3320 NW 53RD ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-6324
Practice Address - Country:US
Practice Address - Phone:954-734-1476
Practice Address - Fax:561-495-0519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299992115251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
108206Medicare PIN
108206Medicare PIN