Provider Demographics
NPI:1326412578
Name:ELITE ADOLESCENT CARE, INC.
Entity Type:Organization
Organization Name:ELITE ADOLESCENT CARE, INC.
Other - Org Name:YOUTHSPRING RESIDENTIAL TREATMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-729-6072
Mailing Address - Street 1:PO BOX 38338
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8338
Mailing Address - Country:US
Mailing Address - Phone:336-763-7287
Mailing Address - Fax:
Practice Address - Street 1:4501 OLD BATTLEGROUND RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9352
Practice Address - Country:US
Practice Address - Phone:336-763-7287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-25
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-1082323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008846Medicaid