MEDICARE: ELEOS,LLC

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1205479383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEOS,LLC

Provider Business Mailing Address
First Line	:	13796 CORDOBA PL
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-8503
Country	:	US
Telephone Number	:	317-698-4452
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 MAPLECREST RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-3980
Country	:	US
Telephone Number	:	260-333-5367
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KHALID KHAN
Credential	:
Telephone Number	:	317-698-4452

Provider Enumeration Date	:	10/22/2019
Last Update Date	:	10/22/2019

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