Provider Demographics
NPI:1104220995
Name:JELIEL SKILLED NURSING AGENCY LLC
Entity Type:Organization
Organization Name:JELIEL SKILLED NURSING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIE JUNIOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUIS-BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-333-3322
Mailing Address - Street 1:1800 ASHBOURNE RD
Mailing Address - Street 2:UNIT 26722
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2595
Mailing Address - Country:US
Mailing Address - Phone:610-333-3322
Mailing Address - Fax:
Practice Address - Street 1:333 POPLAR ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-2227
Practice Address - Country:US
Practice Address - Phone:610-333-3322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health