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General NPI Number Information
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NPI Number | 1760150353
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Entity Type | Organization
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Legal Business Name | ELITE CARE PROVIDERS LLC
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 22600 LAMBERT ST STE 1002
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City | LAKE FOREST
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State | CA
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Zip | 92630-1622
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Country | US
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Telephone | 949-482-2882
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Fax |
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Provider Business Mailing Address
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Address Line | 21545 VINTAGE WAY
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City | LAKE FOREST
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State | CA
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Zip | 92630-5758
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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 | MANAGER
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Name | REN CHELSEA LOPEZ
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Credential |
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Telephone | 909-551-1838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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