Provider Demographics
NPI:1316793656
Name:ELITE RESIDENTIAL FACILITY INC.
Entity type:Organization
Organization Name:ELITE RESIDENTIAL FACILITY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AYODEJI
Authorized Official - Middle Name:
Authorized Official - Last Name:KARUNWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-490-8399
Mailing Address - Street 1:2706 E HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2462
Mailing Address - Country:US
Mailing Address - Phone:310-490-8399
Mailing Address - Fax:
Practice Address - Street 1:2706 E HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2462
Practice Address - Country:US
Practice Address - Phone:310-490-8399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health