Provider Demographics
NPI:1215559810
Name:ELITE COMMUNITY SERVICES, LLC
Entity Type:Organization
Organization Name:ELITE COMMUNITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:APPENZELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-558-1275
Mailing Address - Street 1:3651 E BASELINE RD STE E-222
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2689
Mailing Address - Country:US
Mailing Address - Phone:480-558-1275
Mailing Address - Fax:480-558-1276
Practice Address - Street 1:3651 E BASELINE RD STE E-222
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2689
Practice Address - Country:US
Practice Address - Phone:480-558-1275
Practice Address - Fax:480-558-1276
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE COMMUNITY SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty