Provider Demographics
NPI:1851909170
Name:ELOSKI LLC
Entity Type:Organization
Organization Name:ELOSKI LLC
Other - Org Name:SUPREME PSYCHIATRY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELO
Authorized Official - Middle Name:
Authorized Official - Last Name:OMAKOR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:682-272-5143
Mailing Address - Street 1:3507 TAMARACK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7860
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 DALTON DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4454
Practice Address - Country:US
Practice Address - Phone:682-272-5143
Practice Address - Fax:972-440-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty