Provider Demographics
NPI:1639223795
Name:ELDERHOOD COMMUNITY SERVICES
Entity Type:Organization
Organization Name:ELDERHOOD COMMUNITY SERVICES
Other - Org Name:HOSPICE OF THE GOOD SHEPHERD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SALMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-871-0090
Mailing Address - Street 1:3085 CLAGUE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-1179
Mailing Address - Country:US
Mailing Address - Phone:440-871-0090
Mailing Address - Fax:440-617-9148
Practice Address - Street 1:3085 CLAGUE RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-1179
Practice Address - Country:US
Practice Address - Phone:440-871-0090
Practice Address - Fax:440-617-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0000000000251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based