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General NPI Number Information
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NPI Number | 1518600071
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Entity Type | Organization
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Legal Business Name | ELITE TRIO LLC
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 146 BAYWOOD WAY
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City | HIRAM
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State | GA
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Zip | 30141-3185
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Country | US
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Telephone | 770-462-0456
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Fax | 770-462-0168
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Provider Business Mailing Address
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Address Line | 6065 ROSWELL RD STE 450
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City | ATLANTA
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State | GA
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Zip | 30328-4011
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Country | US
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Telephone | 770-462-0456
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Fax | 770-462-0168
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Authorized Official
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Title or Position | OWNER
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Name | MR. TROY ALLEN WALTON
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Credential |
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Telephone | 770-462-0456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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