Provider Demographics
NPI:1194127357
Name:ELSIE DANIELS
Entity type:Organization
Organization Name:ELSIE DANIELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-635-8691
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:TX
Mailing Address - Zip Code:75925-0206
Mailing Address - Country:US
Mailing Address - Phone:936-635-8691
Mailing Address - Fax:
Practice Address - Street 1:378 MEGGIE SESSIONS ST.
Practice Address - Street 2:
Practice Address - City:ALTO
Practice Address - State:TX
Practice Address - Zip Code:75925
Practice Address - Country:US
Practice Address - Phone:936-635-8691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000615200Medicaid