Provider Demographics
NPI:1083423040
Name:ELITE HOME CARE TRANSPORTATION, LLC
Entity type:Organization
Organization Name:ELITE HOME CARE TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-831-2264
Mailing Address - Street 1:1300 RIDENOUR BLVD NW STE 104
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4528
Mailing Address - Country:US
Mailing Address - Phone:678-831-2264
Mailing Address - Fax:866-571-8385
Practice Address - Street 1:1300 RIDENOUR BLVD NW STE 104
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4528
Practice Address - Country:US
Practice Address - Phone:678-831-2264
Practice Address - Fax:866-571-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)