Provider Demographics
NPI:1932503299
Name:ELITE PERSONAL CARE INC.
Entity Type:Organization
Organization Name:ELITE PERSONAL CARE INC.
Other - Org Name:SOUTHERN HERITAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANICA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-922-6380
Mailing Address - Street 1:814 CARL VINSON PKWY
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31028-1421
Mailing Address - Country:US
Mailing Address - Phone:478-922-6380
Mailing Address - Fax:
Practice Address - Street 1:814 CARL VINSON PKWY
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31028-1421
Practice Address - Country:US
Practice Address - Phone:478-922-6380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center