Healthcare Provider Details

I. General information

NPI: 1609207844
Provider Name (Legal Business Name): ELITE HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 ABBOTT ST SUITE 202
CHARLOTTE NC
28203-4691
US

IV. Provider business mailing address

1910 ABBOTT ST SUITE 202
CHARLOTTE NC
28203-4691
US

V. Phone/Fax

Practice location:
  • Phone: 704-200-9924
  • Fax: 704-665-1881
Mailing address:
  • Phone: 704-200-9924
  • Fax: 704-665-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: TARA ELLERBE
Title or Position: OWNER
Credential:
Phone: 704-200-9924