MEDICARE: ELITECARE TRANSPORT, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1215719596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITECARE TRANSPORT, LLC

Provider Business Mailing Address
First Line	:	160 CENTERPIECE DR
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-1161
Country	:	US
Telephone Number	:	336-897-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 CENTERPIECE DR
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-1161
Country	:	US
Telephone Number	:	336-897-9000
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DRIVER
Name	:	MR. JERMAINE DEMAR JENKINS SR.
Credential	:	N/A
Telephone Number	:	336-897-9000

Provider Enumeration Date	:	10/19/2023
Last Update Date	:	10/19/2023

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