Provider Demographics
NPI:1487984654
Name:ELIZA JAYNE
Entity type:Organization
Organization Name:ELIZA JAYNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRIAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:501-729-5490
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:300 VAN BUREN
Mailing Address - City:JUDSONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72081-0187
Mailing Address - Country:US
Mailing Address - Phone:501-729-5490
Mailing Address - Fax:
Practice Address - Street 1:300 VAN BUREN STREET
Practice Address - Street 2:
Practice Address - City:JUDSONIA
Practice Address - State:AR
Practice Address - Zip Code:72081
Practice Address - Country:US
Practice Address - Phone:501-729-5490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies