Provider Demographics
NPI:1235645185
Name:ELITE SENIOR CARE LLC
Entity Type:Organization
Organization Name:ELITE SENIOR CARE LLC
Other - Org Name:ELITE SENIOR CARE MANAGEMENT COMPANY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-565-5203
Mailing Address - Street 1:P.O. BOX 888
Mailing Address - Street 2:434 HWY 18 BYPASS
Mailing Address - City:MANILLA
Mailing Address - State:AR
Mailing Address - Zip Code:72442
Mailing Address - Country:US
Mailing Address - Phone:870-570-0340
Mailing Address - Fax:844-293-7809
Practice Address - Street 1:434 HWY 18 BYPASS
Practice Address - Street 2:
Practice Address - City:MANILA
Practice Address - State:AR
Practice Address - Zip Code:72442
Practice Address - Country:US
Practice Address - Phone:870-570-0340
Practice Address - Fax:844-293-7809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR222015765251B00000X
251E00000X, 251J00000X, 251X00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR277050732Medicaid
AR222015765Medicaid