Provider Demographics
NPI:1770899445
Name:ELIOT ENTERPRISES, LLC
Entity type:Organization
Organization Name:ELIOT ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUEER
Authorized Official - Suffix:
Authorized Official - Credentials:7245938547
Authorized Official - Phone:724-593-8547
Mailing Address - Street 1:371 BETHEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-2074
Mailing Address - Country:US
Mailing Address - Phone:724-593-8547
Mailing Address - Fax:724-593-7448
Practice Address - Street 1:371 BETHEL CHURCH RD
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-2074
Practice Address - Country:US
Practice Address - Phone:724-593-8547
Practice Address - Fax:724-593-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherFED. ID NUMBER