Provider Demographics
NPI:1063433290
Name:ELITE PROFESSIONALS HOME CARE LLC
Entity type:Organization
Organization Name:ELITE PROFESSIONALS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:402-464-2422
Mailing Address - Street 1:3901 FAULKNER DR.
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4738
Mailing Address - Country:US
Mailing Address - Phone:402-464-2422
Mailing Address - Fax:402-464-2922
Practice Address - Street 1:3901 FAULKNER DR.
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4738
Practice Address - Country:US
Practice Address - Phone:402-464-2422
Practice Address - Fax:402-464-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEHHA201604251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025122700Medicaid
NE287122Medicare Oscar/Certification
NE287122Medicare UPIN