Provider Demographics
NPI:1215824412
Name:ELLIOTT'S LOVE AND CARE SERVICES LLC
Entity type:Organization
Organization Name:ELLIOTT'S LOVE AND CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:VINES GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-258-1672
Mailing Address - Street 1:PO BOX 390592
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-0010
Mailing Address - Country:US
Mailing Address - Phone:404-934-4285
Mailing Address - Fax:
Practice Address - Street 1:3386 SHADY HOLLOW RUN
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-4252
Practice Address - Country:US
Practice Address - Phone:404-934-4285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health