MEDICARE: ELITE CARE AGENCY LLC

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	:	1578245445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	27068 CLAIRVIEW DR
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-1662
Country	:	US
Telephone Number	:	313-334-9182
Fax Number	:

Provider Business Practice Location Address
First Line	:	27068 CLAIRVIEW DR
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-1662
Country	:	US
Telephone Number	:	313-334-9182
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAHMOUD TANANA
Credential	:
Telephone Number	:	313-334-9182

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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