Provider Demographics
NPI:1518093624
Name:ELISE M. BAILEY
Entity Type:Organization
Organization Name:ELISE M. BAILEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.N.
Authorized Official - Prefix:MS
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:864-298-0522
Mailing Address - Street 1:5 CRYSTAL SPRINGS RD
Mailing Address - Street 2:#511
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3124
Mailing Address - Country:US
Mailing Address - Phone:864-298-0522
Mailing Address - Fax:
Practice Address - Street 1:661 RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4640
Practice Address - Country:US
Practice Address - Phone:864-232-2442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR101662314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility