Provider Demographics
NPI:1689799561
Name:ELDERCARE SERVICES INSTITUTE,LLC
Entity Type:Organization
Organization Name:ELDERCARE SERVICES INSTITUTE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:216-373-1605
Mailing Address - Street 1:11890 FAIRHILL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1053
Mailing Address - Country:US
Mailing Address - Phone:216-373-1605
Mailing Address - Fax:216-373-1812
Practice Address - Street 1:11890 FAIRHILL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1053
Practice Address - Country:US
Practice Address - Phone:216-373-1605
Practice Address - Fax:216-373-1812
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENJAMIN ROSE INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-20
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12834OtherCCCMHB UPIN
OH2871165OtherMEDICAID X-OVERS (ODJFS)
OHEL9375361OtherMEDICARE B PTAN
OH367158Medicare Oscar/Certification