Provider Demographics
NPI:1003958935
Name:ELP COMMUNITY HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:ELP COMMUNITY HEALTHCARE SERVICES LLC
Other - Org Name:ELP COMMUNITY HEALTHCARE SERVICES LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZIE KALU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:915-587-9994
Mailing Address - Street 1:513 PHIL HANSEN DR
Mailing Address - Street 2:
Mailing Address - City:CANUTILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79835-8311
Mailing Address - Country:US
Mailing Address - Phone:915-587-9994
Mailing Address - Fax:915-833-0922
Practice Address - Street 1:513 PHIL HANSEN DR
Practice Address - Street 2:
Practice Address - City:CANUTILLO
Practice Address - State:TX
Practice Address - Zip Code:79835-8311
Practice Address - Country:US
Practice Address - Phone:915-587-9994
Practice Address - Fax:915-833-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009014251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350656001Medicaid
TX020250OtherTEXAS HEALTH AND HUMAN SERVICES AGENCY LICENSE