MEDICARE: ELITE CARE CONCIERGE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	163WH0200X	Home Health Registered Nurse
2	101YM0800X	Mental Health Counselor
3	251E00000X	Home Health Agency
4	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1013686880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE CARE CONCIERGE, LLC

Provider Business Mailing Address
First Line	:	6065 ROSWELL RD STE 525
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6065 ROSWELL RD STE 525
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4015
Country	:	US
Telephone Number	:	404-205-5595
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLI J JOHNSON
Credential	:
Telephone Number	:	678-464-7668

Provider Enumeration Date	:	09/07/2021
Last Update Date	:	09/24/2021

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