Provider Demographics
NPI:1447593496
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.O.O.
Authorized Official - Prefix:
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.
Mailing Address - Street 2:#E-222
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:888-558-1275
Mailing Address - Fax:480-558-1276
Practice Address - Street 1:3651 E BASELINE RD
Practice Address - Street 2:#E-222
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2689
Practice Address - Country:US
Practice Address - Phone:888-558-1275
Practice Address - Fax:480-558-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20121451557253Z00000X
AZL-1449513-8253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ385750OtherAHCCCS - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM CERTIFICATION
AZRFQVA DDD710000OtherAZ DEPT. OF ECONOMIC SECURITY CERTIFICATE FOR HOME AND COMMUNITY BASED SERVICES