Imelda's Elderly Care, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

16AL0731-C Issued in MD

Legal business name

IMELDA'S ELDERLY CARE, LLC

Practice address

7805 Glenarden Pkwy
Glenarden, MD 20706-1711

Phone

(240) 432-2674

Fax

(301) 772-0324

NPI assigned

Jun 27, 2008

Last updated

Jun 27, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael A Clarke

Title

Owner

Phone

(301) 773-6384

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1740442029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7805 GLENARDEN PKWY",
            "city": "GLENARDEN",
            "state": "MD",
            "postal_code": "207061711",
            "telephone_number": "240-432-2674",
            "fax_number": "301-772-0324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7805 GLENARDEN PKWY",
            "city": "GLENARDEN",
            "state": "MD",
            "postal_code": "207061711",
            "telephone_number": "240-432-2674",
            "fax_number": "301-772-0324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMELDA'S ELDERLY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-27",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-773-6384",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MD",
            "license": "16AL0731-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "830005700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.