Healthcare Provider Details

I. General information

NPI: 1013686880
Provider Name (Legal Business Name): ELITE CARE CONCIERGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6065 ROSWELL RD STE 525
SANDY SPRINGS GA
30328-4015
US

IV. Provider business mailing address

6065 ROSWELL RD STE 525
SANDY SPRINGS GA
30328-4015
US

V. Phone/Fax

Practice location:
  • Phone: 404-205-5595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ASHLI J JOHNSON
Title or Position: OWNER
Credential:
Phone: 678-464-7668