Healthcare Provider Details

I. General information

NPI: 1497788111
Provider Name (Legal Business Name): ELITE HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 N DAL PASO ST
HOBBS NM
88240-4042
US

IV. Provider business mailing address

PO BOX 2368
HOBBS NM
88241-2368
US

V. Phone/Fax

Practice location:
  • Phone: 575-393-9281
  • Fax: 575-393-9332
Mailing address:
  • Phone: 575-393-9281
  • Fax: 575-393-9332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3226
License Number StateNM

VIII. Authorized Official

Name: MRS. SHARON FORREST
Title or Position: ADMINISTRATOR/OWNER
Credential: RN
Phone: 575-393-9281