Provider Demographics
NPI:1528428489
Name:ELITE HOME HEALTHCARE
Entity type:Organization
Organization Name:ELITE HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHLOE
Authorized Official - Middle Name:GABRIELLE
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-223-3345
Mailing Address - Street 1:5747 W BROADWAY AVE
Mailing Address - Street 2:201
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3549
Mailing Address - Country:US
Mailing Address - Phone:612-223-3345
Mailing Address - Fax:
Practice Address - Street 1:5747 W BROADWAY AVE
Practice Address - Street 2:201
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3549
Practice Address - Country:US
Practice Address - Phone:612-223-3345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization