=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497894349
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELITE HEALTHCARE NURSING SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5411 OLD FREDERICK RD SUITE 2
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21229-2195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-455-6418
-----------------------------------------------------
Fax | 410-455-6419
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 21246
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21228-0746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-455-6418
-----------------------------------------------------
Fax | 410-455-6419
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF NURSING
-----------------------------------------------------
Name | MRS. EVELYN WINFRED SSINABULYA
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 410-455-6418
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------