Provider Demographics
NPI:1063178499
Name:ELITE AFC LLC
Entity type:Organization
Organization Name:ELITE AFC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-955-7825
Mailing Address - Street 1:6480 M 66
Mailing Address - Street 2:
Mailing Address - City:EAST LEROY
Mailing Address - State:MI
Mailing Address - Zip Code:49051-7764
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6480 M 66
Practice Address - Street 2:
Practice Address - City:EAST LEROY
Practice Address - State:MI
Practice Address - Zip Code:49051-7764
Practice Address - Country:US
Practice Address - Phone:973-955-7825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAC130410298OtherSTATE LICENSE