=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124138649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELITE HOMECARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 06/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10605 PATTERSON AVE SUITE D
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23238-4742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-675-4900
-----------------------------------------------------
Fax | 804-675-4364
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 303
-----------------------------------------------------
City | IVY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22945-0303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-296-4155
-----------------------------------------------------
Fax | 804-749-8019
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MS. ANITA JEAN WINFREE
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 434-296-4155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | 0206009178
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------