MEDICARE: ELITE HOME HEALTH CARE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1295927606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE HOME HEALTH CARE INC.

Provider Business Mailing Address
First Line	:	6290 N PORT WASHINGTON RD
Second Line	:	SUITE 100
City	:	GLENDALE
State	:	WI
Zip	:	53217-4312
Country	:	US
Telephone Number	:	414-964-5610
Fax Number	:	414-964-5613

Provider Business Practice Location Address
First Line	:	6290 N PORT WASHINGTON RD
Second Line	:	SUITE 100
City	:	GLENDALE
State	:	WI
Zip	:	53217-4312
Country	:	US
Telephone Number	:	414-964-5610
Fax Number	:	414-964-5613

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	VICTOR SVYATSKY
Credential	:
Telephone Number	:	847-668-4467

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	10/29/2008

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