Provider Demographics
NPI:1598187387
Name:ELITE SENIOR CARE, LLC.
Entity Type:Organization
Organization Name:ELITE SENIOR CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-215-0323
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72451-0491
Mailing Address - Country:US
Mailing Address - Phone:870-215-0323
Mailing Address - Fax:870-215-0323
Practice Address - Street 1:2807 W KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-2605
Practice Address - Country:US
Practice Address - Phone:870-215-0323
Practice Address - Fax:870-215-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR200210251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199713752Medicaid
AR199726757Medicaid
AR199728796Medicaid
AR199850750Medicaid
AR200210765Medicaid