1346691102 NPI number — ELITE HOME CARE

Table of content: (NPI 1346691102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346691102 NPI number — ELITE HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE HOME CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346691102
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1181
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29304-1181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-529-8426
Provider Business Mailing Address Fax Number:
704-919-5011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 BUD ARTHUR BRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29307-4417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-642-1916
Provider Business Practice Location Address Fax Number:
704-919-5011
Provider Enumeration Date:
06/23/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PAINTER
Authorized Official First Name:
GWEN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
864-529-9849

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X , with the licence number: ADC-0406 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: EN0858 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: EX2036 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: EX1507 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: EN1492 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: EX1716 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: EX1827 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: EN1788 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: EY1008 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: EX1828 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: EX0533 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: EY1000 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: EX1348 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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