Healthcare Provider Details

I. General information

NPI: 1952688772
Provider Name (Legal Business Name): ELEOS HOME MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7879 AIRWAY PARK DR
MOBILE AL
36608-9695
US

IV. Provider business mailing address

7879 AIRWAY PARK DR.
MOBILE AL
36608
US

V. Phone/Fax

Practice location:
  • Phone: 251-639-0101
  • Fax: 251-639-0107
Mailing address:
  • Phone: 251-639-0101
  • Fax: 251-639-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. STACEY HOLLAND
Title or Position: MAJORITY OWNER
Credential:
Phone: 251-639-0101