Provider Demographics
NPI:1073997078
Name:ELELYON HEALTH CARE LLC
Entity Type:Organization
Organization Name:ELELYON HEALTH CARE LLC
Other - Org Name:ELELYON HEALTH CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLUYEMISI
Authorized Official - Middle Name:
Authorized Official - Last Name:ESAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-716-0596
Mailing Address - Street 1:607 N FULTON STREET
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488
Mailing Address - Country:US
Mailing Address - Phone:281-716-0596
Mailing Address - Fax:281-858-2367
Practice Address - Street 1:607 N FULTON STREET
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488
Practice Address - Country:US
Practice Address - Phone:281-716-0596
Practice Address - Fax:281-858-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15807Medicare PIN