Provider Demographics
NPI:1346691102
Name:ELITE HOME CARE
Entity Type:Organization
Organization Name:ELITE HOME CARE
Other - Org Name:ELITE DAY CENTER OF SPARTANBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-529-9849
Mailing Address - Street 1:PO BOX 1181
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-1181
Mailing Address - Country:US
Mailing Address - Phone:864-529-8426
Mailing Address - Fax:704-919-5011
Practice Address - Street 1:2000 BUD ARTHUR BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-4417
Practice Address - Country:US
Practice Address - Phone:864-642-1916
Practice Address - Fax:704-919-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 261QA0600X
SCADC-0406261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEN0858Medicaid
SCEX2036Medicaid
SCEX1507Medicaid
SCEN1492Medicaid
SCEX1716Medicaid
SCEX1827Medicaid
SCEN1788Medicaid
SCEY1008Medicaid
SCEX1828Medicaid
SCEX0533Medicaid
SCEY1000Medicaid
SCEX1348Medicaid