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General NPI Number Information
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NPI Number | 1265753321
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Entity Type | Organization
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Legal Business Name | ELI SUPPORT SERVICES
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 06/11/2010
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Provider Practice Location Address
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Address Line | 555 LOS ALTOS ST STE. B
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City | BROWNSVILLE
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State | TX
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Zip | 78520-4343
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Country | US
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Telephone | 361-779-5168
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Fax |
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Provider Business Mailing Address
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Address Line | 555 LOS ALTOS ST STE. B
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City | BROWNSVILLE
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State | TX
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Zip | 78520-4343
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Country | US
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Telephone | 361-779-5168
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DABIAN E CAVAZOS
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Credential |
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Telephone | 361-779-5168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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