MEDICARE: ELSIE FAYE 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	NA	TX

General Provider Information

NPI Number	:	1457954000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELSIE FAYE DANIELS

Provider Business Mailing Address
First Line	:	1020 E TITUS ST
Second Line	:
City	:	MEXIA
State	:	TX
Zip	:	76667-3072
Country	:	US
Telephone Number	:	936-635-8691
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 E TITUS ST
Second Line	:
City	:	MEXIA
State	:	TX
Zip	:	76667-3072
Country	:	US
Telephone Number	:	936-635-8691
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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Directions to “ ELSIE FAYE DANIELS ” Practice Location

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