Provider Demographics
NPI:1912086109
Name:ELLIOTT & ELLIOTT ENTERPRISES
Entity type:Organization
Organization Name:ELLIOTT & ELLIOTT ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-424-1755
Mailing Address - Street 1:3788 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-1959
Mailing Address - Country:US
Mailing Address - Phone:910-424-1755
Mailing Address - Fax:910-424-1405
Practice Address - Street 1:3788 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-1959
Practice Address - Country:US
Practice Address - Phone:910-424-1755
Practice Address - Fax:910-424-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC31613747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601364Medicaid
NC3418005Medicaid