Provider Demographics
NPI:1346732377
Name:ELITE YOUTH & FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:ELITE YOUTH & FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:MALINDA
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:480-628-5339
Mailing Address - Street 1:2620 E AUGUSTA AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4875
Mailing Address - Country:US
Mailing Address - Phone:480-963-8537
Mailing Address - Fax:
Practice Address - Street 1:600 W RAY RD STE D3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7266
Practice Address - Country:US
Practice Address - Phone:480-628-5339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management