Provider Demographics
NPI:1992085963
Name:ELITE CARE INC
Entity type:Organization
Organization Name:ELITE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QM/TRAINING DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEMETRICE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-792-7812
Mailing Address - Street 1:3836 ABBY LYNN DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-7315
Mailing Address - Country:US
Mailing Address - Phone:252-792-7812
Mailing Address - Fax:
Practice Address - Street 1:132 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2472
Practice Address - Country:US
Practice Address - Phone:252-792-7812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6602160Medicaid
NC8301818Medicaid
NC8303113Medicaid