Provider Demographics
NPI:1386310951
Name:ELITE PROFESSIONAL HOMECARE, LLC
Entity type:Organization
Organization Name:ELITE PROFESSIONAL HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JHAMIGKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-357-0773
Mailing Address - Street 1:705 OAK ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MS
Mailing Address - Zip Code:39345-3038
Mailing Address - Country:US
Mailing Address - Phone:601-745-0127
Mailing Address - Fax:
Practice Address - Street 1:405 BRIARWOOD DR STE 205B2
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3052
Practice Address - Country:US
Practice Address - Phone:601-745-0127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1269950OtherNON MEDICAL