MEDICARE: MISS JOSIE ANNETTE ELLIOTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251X00000X	Supports Brokerage Agency
2	253Z00000X	In Home Supportive Care Agency
3	3747P1801X	Personal Care Attendant
4	376J00000X	Homemaker

General Provider Information

NPI Number	:	1801552252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JOSIE ANNETTE ELLIOTT

Provider Business Mailing Address
First Line	:	8040 UPPER TWIN RD
Second Line	:
City	:	SOUTH SALEM
State	:	OH
Zip	:	45681-9732
Country	:	US
Telephone Number	:	740-253-8989
Fax Number	:

Provider Business Practice Location Address
First Line	:	8040 UPPER TWIN RD
Second Line	:
City	:	SOUTH SALEM
State	:	OH
Zip	:	45681-9732
Country	:	US
Telephone Number	:	740-253-8989
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2021
Last Update Date	:	11/10/2021

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