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General NPI Number Information
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NPI Number | 1467741710
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Entity Type | Organization
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Legal Business Name | ELITE HOME CARE
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 6804 BLACKSTONE PL
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City | MABLETON
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State | GA
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Zip | 30126-5441
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Country | US
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Telephone | 678-699-4919
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Fax | 678-402-7965
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Provider Business Mailing Address
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Address Line | 6804 BLACKSTONE PL
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City | MABLETON
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State | GA
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Zip | 30126-5441
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Country | US
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Telephone | 678-699-4919
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Fax | 678-402-7965
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Authorized Official
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Title or Position | CEO
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Name | SHANTEL LONG
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Credential |
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Telephone | 678-699-4919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 033013339
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 033013339
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License Number State | GA
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