Provider Demographics
NPI:1609198233
Name:ELITE PROVIDERS PERSONAL CARE SERVICES, LLC
Entity Type:Organization
Organization Name:ELITE PROVIDERS PERSONAL CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:D
Authorized Official - Last Name:FARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-369-2908
Mailing Address - Street 1:112 EMPORIA LOOP
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6846
Mailing Address - Country:US
Mailing Address - Phone:678-369-2908
Mailing Address - Fax:
Practice Address - Street 1:112 EMPORIA LOOP
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6846
Practice Address - Country:US
Practice Address - Phone:678-369-2908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care