Provider Demographics
NPI:1710686811
Name:ELITE CARE SERVICES LLC
Entity Type:Organization
Organization Name:ELITE CARE SERVICES LLC
Other - Org Name:ELITE CARE SERVICES LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:SEDONIA
Authorized Official - Last Name:BUTLER-STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-722-1451
Mailing Address - Street 1:14649 230TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-4423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14649 230TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-4423
Practice Address - Country:US
Practice Address - Phone:718-200-9384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty