Provider Demographics
NPI:1780929075
Name:ELITE GARDEN HOMES, INC.
Entity type:Organization
Organization Name:ELITE GARDEN HOMES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SONA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:414-241-5019
Mailing Address - Street 1:10501 W BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2673
Mailing Address - Country:US
Mailing Address - Phone:414-459-3275
Mailing Address - Fax:414-434-4207
Practice Address - Street 1:11414 W PARK PL
Practice Address - Street 2:SUITE 202
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-3500
Practice Address - Country:US
Practice Address - Phone:414-459-3275
Practice Address - Fax:414-434-4207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1157251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1157OtherWISCONSIN STATE HOME HEALTH LICENSE