Provider Demographics
NPI:1851891899
Name:ELITE HEALTHCARE AGENCY INC.
Entity Type:Organization
Organization Name:ELITE HEALTHCARE AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEIGHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-333-2429
Mailing Address - Street 1:981 AUTUMN PINES DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2688
Mailing Address - Country:US
Mailing Address - Phone:904-333-2429
Mailing Address - Fax:
Practice Address - Street 1:981 AUTUMN PINES DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-2688
Practice Address - Country:US
Practice Address - Phone:904-333-2429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
FL261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care