Healthcare Provider Details

I. General information

NPI: 1215151717
Provider Name (Legal Business Name): ELITE HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MAIN ST SUITE 180
HACKENSACK NJ
07601-7052
US

IV. Provider business mailing address

131 MAIN ST SUITE 180
HACKENSACK NJ
07601-7052
US

V. Phone/Fax

Practice location:
  • Phone: 201-862-1300
  • Fax: 201-837-2074
Mailing address:
  • Phone: 201-862-1300
  • Fax: 201-837-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7887507
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MS. SAM PESSAR
Title or Position: PRESIDENT
Credential:
Phone: 201-862-1300