Provider Demographics
NPI:1467741710
Name:ELITE HOME CARE
Entity Type:Organization
Organization Name:ELITE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-699-4919
Mailing Address - Street 1:6804 BLACKSTONE PL
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-5441
Mailing Address - Country:US
Mailing Address - Phone:678-699-4919
Mailing Address - Fax:678-402-7965
Practice Address - Street 1:6804 BLACKSTONE PL
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-5441
Practice Address - Country:US
Practice Address - Phone:678-699-4919
Practice Address - Fax:678-402-7965
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWMAN & LONG ENTERPRISE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033013339320800000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities