=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295869915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELITE NURSING STAFF INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 OLD WAREHOUSE SQ
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27565-2953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-693-6400
-----------------------------------------------------
Fax | 919-692-1011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 OLD WAREHOUSE SQ
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27565-2953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-693-6400
-----------------------------------------------------
Fax | 919-692-1011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. HASSAN HARRIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-693-6400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC3215
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------