Provider Demographics
NPI:1245742667
Name:ELITE HOMECARE INCORPORATED
Entity Type:Organization
Organization Name:ELITE HOMECARE INCORPORATED
Other - Org Name:SYNERGY HOMECARE OF PRESCOTT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNE
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-515-3318
Mailing Address - Street 1:7762 E FLORENTINE RD STE D
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1209
Mailing Address - Country:US
Mailing Address - Phone:928-515-3318
Mailing Address - Fax:928-441-0554
Practice Address - Street 1:7762 E FLORENTINE RD STE D
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1209
Practice Address - Country:US
Practice Address - Phone:928-515-3318
Practice Address - Fax:928-441-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care