Healthcare Provider Details

I. General information

NPI: 1780549816
Provider Name (Legal Business Name): ELITE HOMECARE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 W GLASS LN
PHOENIX AZ
85041-6362
US

IV. Provider business mailing address

2904 W GLASS LN
PHOENIX AZ
85041-6362
US

V. Phone/Fax

Practice location:
  • Phone: 657-253-6812
  • Fax:
Mailing address:
  • Phone: 657-253-6812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EMMANUEL RAYMOND
Title or Position: ADMINISTRATOR
Credential:
Phone: 657-253-6812