Provider Demographics
NPI:1003488891
Name:ELITE SUPPORTIVE LIVING SERVICES
Entity Type:Organization
Organization Name:ELITE SUPPORTIVE LIVING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:513-370-9526
Mailing Address - Street 1:2432 BUDDLEIA CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6880
Mailing Address - Country:US
Mailing Address - Phone:513-370-9526
Mailing Address - Fax:
Practice Address - Street 1:954 W NORTH BEND RD STE 304B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-2250
Practice Address - Country:US
Practice Address - Phone:513-607-0384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty