Healthcare Provider Details

I. General information

NPI: 1124770102
Provider Name (Legal Business Name): ELITE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 COLLINS DR
LAS VEGAS NM
87701-4827
US

IV. Provider business mailing address

2306 COLLINS DR
LAS VEGAS NM
87701-4827
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-9416
  • Fax:
Mailing address:
  • Phone: 505-425-9496
  • Fax: 505-454-0787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARAH PACHECO
Title or Position: DIRECTOR
Credential:
Phone: 505-652-8032