=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730613878
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELITE NURSING CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2017
-----------------------------------------------------
Last Update Date | 04/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9222 LEE MASEY DR
-----------------------------------------------------
City | LORTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22079-4709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-247-3366
-----------------------------------------------------
Fax | 703-372-2492
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17717 AVENEL LN DUMFRIES
-----------------------------------------------------
City | DUMFRIES
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22026-4569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-247-3366
-----------------------------------------------------
Fax | 703-372-2492
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, CEO
-----------------------------------------------------
Name | MRS. KADIJAH SKEIKY
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 571-247-3366
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------