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General NPI Number Information
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NPI Number | 1841420924
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Entity Type | Organization
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Legal Business Name | ELT INC.
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 07/22/2009
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Provider Practice Location Address
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Address Line | 25 DAY ST
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City | ROLLING FORK
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State | MS
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Zip | 39159-5128
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Country | US
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Telephone | 662-873-6964
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Fax | 662-873-6020
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Provider Business Mailing Address
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Address Line | PO BOX 490
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City | ROLLING FORK
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State | MS
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Zip | 39159-0490
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Country | US
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Telephone | 662-873-6964
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Fax | 662-873-6020
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. EMMA LEE TANKSON
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Credential |
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Telephone | 662-873-6964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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