Provider Demographics
NPI:1558191106
Name:ELENA HOME HEALTHCARE
Entity type:Organization
Organization Name:ELENA HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANEESAH
Authorized Official - Middle Name:KAAMIL
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:602-752-8251
Mailing Address - Street 1:7203 W SOUTHGATE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-6605
Mailing Address - Country:US
Mailing Address - Phone:602-752-8251
Mailing Address - Fax:
Practice Address - Street 1:7203 W SOUTHGATE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-6605
Practice Address - Country:US
Practice Address - Phone:602-752-8251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health