Provider Demographics
NPI:1720382534
Name:ELITE HOME CARE SERVICES
Entity Type:Organization
Organization Name:ELITE HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-926-3385
Mailing Address - Street 1:965 ISLAND BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5575
Mailing Address - Country:US
Mailing Address - Phone:678-926-3385
Mailing Address - Fax:
Practice Address - Street 1:965 ISLAND BLUFF LN
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5575
Practice Address - Country:US
Practice Address - Phone:678-926-3385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-08
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067R0789253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care