Provider Demographics
NPI:1093309015
Name:ELITES CARE, LLC
Entity Type:Organization
Organization Name:ELITES CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AWONTI
Authorized Official - Middle Name:
Authorized Official - Last Name:ETOO NDJONGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-660-9101
Mailing Address - Street 1:6911 RICHMOND HWY STE 302
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1846
Mailing Address - Country:US
Mailing Address - Phone:703-660-9101
Mailing Address - Fax:
Practice Address - Street 1:6911 RICHMOND HWY STE 302
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1846
Practice Address - Country:US
Practice Address - Phone:703-660-9101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness