MEDICARE: ELITE HOME CARE, 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	:	1659935666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE HOME CARE, LLC

Provider Business Mailing Address
First Line	:	5536 HEBERT ST APT A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63120-1623
Country	:	US
Telephone Number	:	314-400-8484
Fax Number	:	314-480-7177

Provider Business Practice Location Address
First Line	:	5536 HEBERT ST APT A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63120-1623
Country	:	US
Telephone Number	:	314-400-8484
Fax Number	:	314-480-7177

Authorized Official
Title or Position	:	OWNER/CDS COORDINATOR
Name	:	TAYON HENDERSON
Credential	:
Telephone Number	:	314-400-8484

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	04/24/2019

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