Provider Demographics
NPI:1811687296
Name:ELIZA LLC
Entity type:Organization
Organization Name:ELIZA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MICHEA DANINE
Authorized Official - Last Name:CONLEY-LEPENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-480-9183
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-0282
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21HI WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043
Practice Address - Country:US
Practice Address - Phone:207-313-9114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIZA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty