Provider Demographics
NPI:1255940896
Name:ELDERLESCENT CARE INCORPORATED
Entity type:Organization
Organization Name:ELDERLESCENT CARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:JAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, MDIV
Authorized Official - Phone:804-255-9993
Mailing Address - Street 1:6767 FOREST HILL AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1852
Mailing Address - Country:US
Mailing Address - Phone:804-255-9993
Mailing Address - Fax:804-203-8008
Practice Address - Street 1:3520 SKIPPING ROCK WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23234-2971
Practice Address - Country:US
Practice Address - Phone:804-683-9630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care