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General NPI Number Information
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NPI Number | 1902289184
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Entity Type | Organization
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Legal Business Name | ELITECARE HOME CARE AGENCY LLC
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 12/04/2015
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Provider Practice Location Address
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Address Line | 500 W SILVER SPRING DR. SUITE K -200
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City | GLENDALE
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State | WI
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Zip | 53217-2564
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Country | US
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Telephone | 262-515-5970
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Fax |
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Provider Business Mailing Address
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Address Line | 901 W WINNEBAGO ST APT 314
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City | MILWAUKEE
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State | WI
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Zip | 53205-2564
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Country | US
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Telephone | 262-515-5970
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LASONIA SMITH
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Credential |
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Telephone | 262-515-5970
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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 |
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