Provider Demographics
NPI:1144059015
Name:ELITE CARE HOME
Entity type:Organization
Organization Name:ELITE CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO AND COOWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-918-9533
Mailing Address - Street 1:1520 29TH AVE STE 16
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2843
Mailing Address - Country:US
Mailing Address - Phone:228-596-5911
Mailing Address - Fax:
Practice Address - Street 1:1520 29TH AVE STE 16
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2843
Practice Address - Country:US
Practice Address - Phone:228-596-5911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No385H00000XRespite Care FacilityRespite Care