Healthcare Provider Details

I. General information

NPI: 1164767638
Provider Name (Legal Business Name): ELISKA CONCEPTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 HONEYSUCKLE DR
STEENS MS
39766-8803
US

IV. Provider business mailing address

107 HONEYSUCKLE DR
STEENS MS
39766-8803
US

V. Phone/Fax

Practice location:
  • Phone: 662-574-0903
  • Fax:
Mailing address:
  • Phone: 662-574-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMS

VIII. Authorized Official

Name: MR. THOMAS LEE PUMPHREY
Title or Position: CEO
Credential: PHYSICAL THERAPIST
Phone: 662-574-0903