Provider Demographics
NPI:1144785486
Name:ELITE CONCIERGE CARE, LLC
Entity Type:Organization
Organization Name:ELITE CONCIERGE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN/CARE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:318-626-5036
Mailing Address - Street 1:2535 BERT KOUNS INDUSTRIAL LOOP STE 203-138
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3159
Mailing Address - Country:US
Mailing Address - Phone:318-626-5036
Mailing Address - Fax:318-626-5034
Practice Address - Street 1:9051 MANSFIELD RD STE C3
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2682
Practice Address - Country:US
Practice Address - Phone:318-626-5036
Practice Address - Fax:318-626-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care