Provider Demographics
NPI:1629430889
Name:ELDERCARE MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:ELDERCARE MEDICAL SUPPLIES, LLC
Other - Org Name:ELDERLY BABY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-224-6245
Mailing Address - Street 1:1450 W GRAND PKWY S
Mailing Address - Street 2:SUITE 408
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8204
Mailing Address - Country:US
Mailing Address - Phone:281-224-6245
Mailing Address - Fax:281-769-9800
Practice Address - Street 1:531 PROMENADE BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2441
Practice Address - Country:US
Practice Address - Phone:281-224-6245
Practice Address - Fax:281-769-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies