MEDICARE: ELITE PASSPORT SERVICES, 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	:	1871873034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE PASSPORT SERVICES, LLC

Provider Business Mailing Address
First Line	:	2862 JOHNSTOWN RD.
Second Line	:	SUITE 207
City	:	COLUMBUS
State	:	OH
Zip	:	43219-3824
Country	:	US
Telephone Number	:	614-472-0999
Fax Number	:

Provider Business Practice Location Address
First Line	:	2862 JOHNSTOWN RD.
Second Line	:	SUITE 207
City	:	COLUMBUS
State	:	OH
Zip	:	43219-3824
Country	:	US
Telephone Number	:	614-472-0999
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/DIRECTOR OF NURSING
Name	:	MS. URSULA BARASH
Credential	:	RN
Telephone Number	:	614-472-0999

Provider Enumeration Date	:	08/19/2011
Last Update Date	:	08/19/2011

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