Provider Demographics
NPI:1790383594
Name:ELITE CAREGIVERS NURSING AGENCY LLC
Entity Type:Organization
Organization Name:ELITE CAREGIVERS NURSING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEOLA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-864-7034
Mailing Address - Street 1:10015 OLD COLUMBIA RD STE B215
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1865
Mailing Address - Country:US
Mailing Address - Phone:703-864-7034
Mailing Address - Fax:
Practice Address - Street 1:10015 OLD COLUMBIA RD STE B215
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1865
Practice Address - Country:US
Practice Address - Phone:703-864-7034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health