Provider Demographics
NPI:1942709464
Name:ELIA, ROSE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:ELIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 CHADBOURNE ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5609
Mailing Address - Country:US
Mailing Address - Phone:903-283-0857
Mailing Address - Fax:
Practice Address - Street 1:5130 CHADBOURNE ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5609
Practice Address - Country:US
Practice Address - Phone:903-283-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-10
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health