Provider Demographics
NPI:1033814959
Name:ELITE RENEWCARE, LLC
Entity Type:Organization
Organization Name:ELITE RENEWCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:ROSELIA
Authorized Official - Last Name:SANTOS-BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:NP-BC
Authorized Official - Phone:315-489-5440
Mailing Address - Street 1:305 DERBY LN
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-7556
Mailing Address - Country:US
Mailing Address - Phone:315-489-5440
Mailing Address - Fax:
Practice Address - Street 1:4111E ROSE LAKE DR # 4827
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-2858
Practice Address - Country:US
Practice Address - Phone:315-489-5440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty