Provider Demographics
NPI:1316654643
Name:ELITE HOME CARE, LLC
Entity type:Organization
Organization Name:ELITE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EZINNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKWUDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-347-9991
Mailing Address - Street 1:16012 S WESTERN AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16012 S WESTERN AVE STE 306
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3763
Practice Address - Country:US
Practice Address - Phone:310-819-8744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health