Provider Demographics
NPI:1659935666
Name:ELITE HOME CARE, LLC
Entity Type:Organization
Organization Name:ELITE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CDS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAYON
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-400-8484
Mailing Address - Street 1:5536 HEBERT ST APT A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63120-1623
Mailing Address - Country:US
Mailing Address - Phone:314-400-8484
Mailing Address - Fax:314-480-7177
Practice Address - Street 1:5536 HEBERT ST APT A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63120-1623
Practice Address - Country:US
Practice Address - Phone:314-400-8484
Practice Address - Fax:314-480-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health