Provider Demographics
NPI:1700382983
Name:365 ELITE HOME CARE LLC
Entity Type:Organization
Organization Name:365 ELITE HOME CARE LLC
Other - Org Name:365 ELITE HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEMEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOWATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-217-0683
Mailing Address - Street 1:321 BRACKIN TRCE
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4068
Mailing Address - Country:US
Mailing Address - Phone:770-217-0683
Mailing Address - Fax:770-454-0118
Practice Address - Street 1:321 BRACKIN TRCE
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-4068
Practice Address - Country:US
Practice Address - Phone:770-217-0683
Practice Address - Fax:770-454-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health