Healthcare Provider Details

I. General information

NPI: 1619830072
Provider Name (Legal Business Name): ELITE ELEVATION HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 W MARKET ST
FAIRLAWN OH
44333-3301
US

IV. Provider business mailing address

3111 W MARKET ST
FAIRLAWN OH
44333-3301
US

V. Phone/Fax

Practice location:
  • Phone: 330-983-9240
  • Fax:
Mailing address:
  • Phone: 330-983-9240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE SHOATES
Title or Position: CEO
Credential:
Phone: 330-780-1598