Healthcare Provider Details

I. General information

NPI: 1750114740
Provider Name (Legal Business Name): ELIM'S GATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W WENGER RD STE C3
ENGLEWOOD OH
45322-2761
US

IV. Provider business mailing address

130 W WENGER RD STE C3
ENGLEWOOD OH
45322-2761
US

V. Phone/Fax

Practice location:
  • Phone: 937-825-4618
  • Fax:
Mailing address:
  • Phone: 937-825-4618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELIQUE OLUYITAN
Title or Position: PRESIDENT
Credential: RN
Phone: 937-613-2550