Healthcare Provider Details

I. General information

NPI: 1649953852
Provider Name (Legal Business Name): ELITECARE HEALTHSERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 BUTTERNUT PL
COLLEGE PARK GA
30349
US

IV. Provider business mailing address

4280 BUTTERNUT PLACE
COLLEGE PARK GA
30349
US

V. Phone/Fax

Practice location:
  • Phone: 404-480-4116
  • Fax:
Mailing address:
  • Phone: 404-480-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LAKITA RUSHING
Title or Position: ADMINISTRATOR
Credential:
Phone: 404-883-1575