Provider Demographics
NPI:1629343900
Name:ELDER ASSISTANCE, LLC
Entity Type:Organization
Organization Name:ELDER ASSISTANCE, LLC
Other - Org Name:ELDER ASSISTANCE OF NEW PORT RICHEY, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-326-4432
Mailing Address - Street 1:5623 US HIGHWAY 19
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3700
Mailing Address - Country:US
Mailing Address - Phone:727-326-4432
Mailing Address - Fax:
Practice Address - Street 1:5620 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2650
Practice Address - Country:US
Practice Address - Phone:727-326-4432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230919253Z00000X
FL9179311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000732100Medicaid