Provider Demographics
NPI:1720197866
Name:ELDER HEALTH CARE OF VOLUSIA, P.A.
Entity Type:Organization
Organization Name:ELDER HEALTH CARE OF VOLUSIA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:386-774-0491
Mailing Address - Street 1:2669 ENTERPRISE RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8217
Mailing Address - Country:US
Mailing Address - Phone:386-774-0491
Mailing Address - Fax:386-774-7854
Practice Address - Street 1:2669 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8217
Practice Address - Country:US
Practice Address - Phone:386-774-0491
Practice Address - Fax:386-774-7854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty