Provider Demographics
NPI:1346587334
Name:ELITE PROFESSIONALS HOME CARE LLC
Entity Type:Organization
Organization Name:ELITE PROFESSIONALS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER - OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CALLIE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:EARLYWINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-339-7727
Mailing Address - Street 1:13306 A ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3660
Mailing Address - Country:US
Mailing Address - Phone:402-339-7727
Mailing Address - Fax:402-614-3141
Practice Address - Street 1:13306 A STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144
Practice Address - Country:US
Practice Address - Phone:402-339-7727
Practice Address - Fax:402-614-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEHHA201604251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025122700Medicaid
NE10025122700Medicaid