Provider Demographics
NPI:1447580618
Name:ELDERLY MIND AND SPIRTS
Entity Type:Organization
Organization Name:ELDERLY MIND AND SPIRTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:SIERRA
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-847-1526
Mailing Address - Street 1:147 FAIRMOUNT AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2432
Mailing Address - Country:US
Mailing Address - Phone:973-486-0337
Mailing Address - Fax:
Practice Address - Street 1:147 FAIRMOUNT AVE FL 1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2432
Practice Address - Country:US
Practice Address - Phone:908-486-0337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health