Provider Demographics
NPI:1467525568
Name:ELDERWISE HOMECARE INC.
Entity Type:Organization
Organization Name:ELDERWISE HOMECARE INC.
Other - Org Name:ELDERRWISE RESOURCE NETWORK
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MR
Authorized Official - First Name:PARIS
Authorized Official - Middle Name:JON
Authorized Official - Last Name:KANTAS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:619-248-7044
Mailing Address - Street 1:7486 LA JOLLA BLVD
Mailing Address - Street 2:#552
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5029
Mailing Address - Country:US
Mailing Address - Phone:619-248-7044
Mailing Address - Fax:619-434-9573
Practice Address - Street 1:7486 LA JOLLA BLVD
Practice Address - Street 2:#552
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5029
Practice Address - Country:US
Practice Address - Phone:619-248-7044
Practice Address - Fax:619-434-9573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health