Provider Demographics
NPI:1114302742
Name:ELIXIR HOME HEALTH CARE & HOSPICE,INC.
Entity Type:Organization
Organization Name:ELIXIR HOME HEALTH CARE & HOSPICE,INC.
Other - Org Name:ELIXIR HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAVED
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-369-5110
Mailing Address - Street 1:1420 W KETTLEMAN LN
Mailing Address - Street 2:SUITE S2
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-4557
Mailing Address - Country:US
Mailing Address - Phone:209-369-5110
Mailing Address - Fax:209-396-5130
Practice Address - Street 1:1420 W KETTLEMAN LN
Practice Address - Street 2:SUITE S2
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4557
Practice Address - Country:US
Practice Address - Phone:209-369-5110
Practice Address - Fax:209-396-5130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health