MEDICARE: ELITE HOME CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1518771492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE HOME CARE LLC

Provider Business Mailing Address
First Line	:	7401 S BITTERROOT PL STE 205
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-1609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7401 S BITTERROOT PL STE 205
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-1609
Country	:	US
Telephone Number	:	920-224-5178
Fax Number	:

Authorized Official
Title or Position	:	CAO
Name	:	CHANTAL BYISHIMO
Credential	:
Telephone Number	:	920-224-5178

Provider Enumeration Date	:	02/03/2025
Last Update Date	:	02/03/2025

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Directions to “ELITE HOME CARE LLC ” Practice Location

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