Provider Demographics
NPI:1912480393
Name:ELDER CARE SERVICES, INC.
Entity Type:Organization
Organization Name:ELDER CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-245-5925
Mailing Address - Street 1:2518 W TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-2506
Mailing Address - Country:US
Mailing Address - Phone:850-245-5925
Mailing Address - Fax:
Practice Address - Street 1:1660 N MONROE ST STE 11
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5558
Practice Address - Country:US
Practice Address - Phone:850-222-4208
Practice Address - Fax:850-222-0330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELDER CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
9049OtherAHCA
FL692164700Medicaid