Provider Demographics
NPI:1962042689
Name:ELDERLY CENTRAL LLC
Entity Type:Organization
Organization Name:ELDERLY CENTRAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:COLLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-250-9770
Mailing Address - Street 1:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96141-0843
Mailing Address - Country:US
Mailing Address - Phone:408-966-5364
Mailing Address - Fax:
Practice Address - Street 1:5790 LAGOON ROAD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:CA
Practice Address - Zip Code:96141-9614
Practice Address - Country:US
Practice Address - Phone:917-250-9770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies