Provider Demographics
NPI:1841602505
Name:LUCILLE'S ELITE TEAM HOME HEALTH CARE
Entity Type:Organization
Organization Name:LUCILLE'S ELITE TEAM HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUCILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:209-688-5841
Mailing Address - Street 1:95 W 11TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3961
Mailing Address - Country:US
Mailing Address - Phone:209-814-4015
Mailing Address - Fax:
Practice Address - Street 1:95 W 11TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3959
Practice Address - Country:US
Practice Address - Phone:209-814-4015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA693652251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health