Basic Information
| Provider Information | |||||||||
| NPI: | 1114085891 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ELDERWATCH PLUS | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7536 HAVERFORD AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191512109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158770202 | ||||||||
| FaxNumber: | 2158783315 | ||||||||
| Practice Location | |||||||||
| Address1: | 7536 HAVERFORD AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191512109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158770202 | ||||||||
| FaxNumber: | 2158783315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 10/18/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | AHRAM | ||||||||
| AuthorizedOfficialFirstName: | JUDI | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2158770202 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
No ID Information.