Provider Demographics
NPI:1619113735
Name:ELDER HOUSE ADULT DAY CARE CENTER
Entity Type:Organization
Organization Name:ELDER HOUSE ADULT DAY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:LA QUITA
Authorized Official - Last Name:RAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-875-1711
Mailing Address - Street 1:615 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-5766
Mailing Address - Country:US
Mailing Address - Phone:870-875-1711
Mailing Address - Fax:870-875-1122
Practice Address - Street 1:615 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5766
Practice Address - Country:US
Practice Address - Phone:870-875-1711
Practice Address - Fax:870-875-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR00-306251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management