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General NPI Number Information
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NPI Number | 1780929075
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Entity Type | Organization
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Legal Business Name | ELITE GARDEN HOMES, INC.
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 11414 W PARK PL SUITE 202
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City | MILWAUKEE
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State | WI
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Zip | 53224-3500
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Country | US
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Telephone | 414-459-3275
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Fax | 414-434-4207
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Provider Business Mailing Address
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Address Line | 10501 W BRADLEY RD
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City | MILWAUKEE
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State | WI
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Zip | 53224-2673
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Country | US
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Telephone | 414-459-3275
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Fax | 414-434-4207
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Authorized Official
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Title or Position | CEO
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Name | MR. JERRY SONA
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Credential | CEO
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Telephone | 414-241-5019
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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 | 1157
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License Number State | WI
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