Provider Demographics
NPI:1235784893
Name:ELITE CARE, LLC
Entity Type:Organization
Organization Name:ELITE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER/ ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-229-1523
Mailing Address - Street 1:130 WEST 2ND ST.
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-3708
Mailing Address - Country:US
Mailing Address - Phone:501-229-1523
Mailing Address - Fax:501-229-2929
Practice Address - Street 1:130 WEST 2ND ST.
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-3708
Practice Address - Country:US
Practice Address - Phone:501-229-1523
Practice Address - Fax:501-229-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR209345757Medicaid
AR202881732Medicaid
AR207221797Medicaid