Provider Demographics
NPI:1619646148
Name:ELITE RESIDENTIAL CARE, LLC
Entity Type:Organization
Organization Name:ELITE RESIDENTIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON-FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-430-0411
Mailing Address - Street 1:1321 MURFREESBORO PIKE STE 541
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2643
Mailing Address - Country:US
Mailing Address - Phone:615-430-0411
Mailing Address - Fax:615-503-8744
Practice Address - Street 1:1321 MURFREESBORO PIKE STE 541
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-2643
Practice Address - Country:US
Practice Address - Phone:615-430-0411
Practice Address - Fax:615-503-8744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services