Provider Demographics
NPI:1417107111
Name:ELISHA MINISTRIES
Entity Type:Organization
Organization Name:ELISHA MINISTRIES
Other - Org Name:SUPPORTIVE HOUSING OF NORTHEAST LA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:APMHNP-BC
Authorized Official - Phone:318-251-1233
Mailing Address - Street 1:608 S TRENTON ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5041
Mailing Address - Country:US
Mailing Address - Phone:318-251-1233
Mailing Address - Fax:318-254-5023
Practice Address - Street 1:608 S TRENTON ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5041
Practice Address - Country:US
Practice Address - Phone:318-251-1233
Practice Address - Fax:318-254-5023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN064413 AP03033251B00000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)