Provider Demographics
NPI:1619635166
Name:ELITE GENERATIONAL HOME CARE LLC
Entity Type:Organization
Organization Name:ELITE GENERATIONAL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:D
Authorized Official - Last Name:HENRICY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:270-875-5353
Mailing Address - Street 1:14963 19TH ST N
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14963 19TH ST N
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4804
Practice Address - Country:US
Practice Address - Phone:270-875-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care