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General NPI Number Information
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NPI Number | 1245742667
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Entity Type | Organization
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Legal Business Name | ELITE HOMECARE INCORPORATED
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Dates
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Enumeration Date | 10/25/2017
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 7762 E FLORENTINE RD STE D
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1209
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Country | US
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Telephone | 928-515-3318
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Fax | 928-441-0554
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Provider Business Mailing Address
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Address Line | 7762 E FLORENTINE RD STE D
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1209
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Country | US
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Telephone | 928-515-3318
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Fax | 928-441-0554
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Authorized Official
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Title or Position | OWNE
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Name | ALAN WIKMAN
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Credential |
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Telephone | 928-515-3318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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