Healthcare Provider Details

I. General information

NPI: 1528655388
Provider Name (Legal Business Name): ELITE PERSONAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8855 N CORTONA CIR
CORDOVA TN
38018-6978
US

IV. Provider business mailing address

8855 N CORTONA CIR
CORDOVA TN
38018-6978
US

V. Phone/Fax

Practice location:
  • Phone: 901-282-9124
  • Fax:
Mailing address:
  • Phone: 901-282-9124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. LATONYA ADDISON
Title or Position: OWNER
Credential: LPN
Phone: 901-282-9124