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General NPI Number Information
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NPI Number | 1679900914
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Entity Type | Organization
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Legal Business Name | HOME CARE ELITE
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Dates
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Enumeration Date | 10/01/2013
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Last Update Date | 10/01/2013
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Provider Practice Location Address
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Address Line | 5706 NOTRE DAME DR
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City | AMARILLO
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State | TX
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Zip | 79109-6662
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Country | US
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Telephone | 806-206-7119
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Fax |
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Provider Business Mailing Address
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Address Line | 5706 NOTRE DAME DR
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City | AMARILLO
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State | TX
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Zip | 79109-6662
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MR. JACKSON DICEMAN JEFFERS
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Credential | BAA
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Telephone | 806-206-7119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | TX
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