Healthcare Provider Details

I. General information

NPI: 1063433290
Provider Name (Legal Business Name): ELITE PROFESSIONALS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 FAULKNER DR.
LINCOLN NE
68516-4738
US

IV. Provider business mailing address

3901 FAULKNER DR.
LINCOLN NE
68516-4738
US

V. Phone/Fax

Practice location:
  • Phone: 402-464-2422
  • Fax: 402-464-2922
Mailing address:
  • Phone: 402-464-2422
  • Fax: 402-464-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA201604
License Number StateNE

VIII. Authorized Official

Name: JENNIFER K GIBBONS
Title or Position: OWNER/PRESIDENT
Credential: RN
Phone: 402-464-2422