Provider Demographics
NPI:1306670476
Name:WILLS-ECKFORD, ELIAS JAMES-OSCAR
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:JAMES-OSCAR
Last Name:WILLS-ECKFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3303
Mailing Address - Country:US
Mailing Address - Phone:313-929-5106
Mailing Address - Fax:
Practice Address - Street 1:137 COLORADO ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3303
Practice Address - Country:US
Practice Address - Phone:313-929-5106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 253Z00000X
MI374U00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide