Provider Demographics
NPI:1215719596
Name:ELITECARE TRANSPORT, LLC
Entity type:Organization
Organization Name:ELITECARE TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DRIVER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:DEMAR
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:SR
Authorized Official - Credentials:N/A
Authorized Official - Phone:336-897-9000
Mailing Address - Street 1:160 CENTERPIECE DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1161
Mailing Address - Country:US
Mailing Address - Phone:336-897-9000
Mailing Address - Fax:
Practice Address - Street 1:160 CENTERPIECE DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1161
Practice Address - Country:US
Practice Address - Phone:336-897-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)