MEDICARE: ELSIE DANIELS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194127357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELSIE DANIELS

Provider Business Mailing Address
First Line	:	PO BOX 206
Second Line	:
City	:	ALTO
State	:	TX
Zip	:	75925-0206
Country	:	US
Telephone Number	:	936-635-8691
Fax Number	:

Provider Business Practice Location Address
First Line	:	378 MEGGIE SESSIONS ST.
Second Line	:
City	:	ALTO
State	:	TX
Zip	:	75925
Country	:	US
Telephone Number	:	936-635-8691
Fax Number	:

Authorized Official
Title or Position	:	HEALTHCARE PROVIDER
Name	:	ELSIE FAY DANIELS
Credential	:
Telephone Number	:	936-635-8691

Provider Enumeration Date	:	09/19/2014
Last Update Date	:	11/06/2019

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