Provider Demographics
NPI:1699292367
Name:ELDER PATH INC.
Entity type:Organization
Organization Name:ELDER PATH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GERONTOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERVONNE
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MSG
Authorized Official - Phone:757-240-7928
Mailing Address - Street 1:4410 E CLAIBORNE SQ. STE 334
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2200
Mailing Address - Country:US
Mailing Address - Phone:757-251-3838
Mailing Address - Fax:757-282-5857
Practice Address - Street 1:4410 E CLAIBORNE SQ. STE 334
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:22366-2200
Practice Address - Country:US
Practice Address - Phone:757-251-3838
Practice Address - Fax:757-282-5857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty