Provider Demographics
NPI:1174997746
Name:ELITE HOME HEALTH CARE INC
Entity type:Organization
Organization Name:ELITE HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCKENS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:262-221-1270
Mailing Address - Street 1:829 S. GREENBAY ROAD SUITE 110
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4058
Mailing Address - Country:US
Mailing Address - Phone:262-221-1270
Mailing Address - Fax:262-456-6100
Practice Address - Street 1:829 S. GREENBAY ROAD SUITE 110
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4058
Practice Address - Country:US
Practice Address - Phone:262-221-1270
Practice Address - Fax:262-456-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1193251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1193OtherHOME HEALTH LICENSE