Provider Demographics
NPI:1760904338
Name:ELITE RESIDENTIAL, LLC
Entity Type:Organization
Organization Name:ELITE RESIDENTIAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:LETOINDIA
Authorized Official - Last Name:BETTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-367-8634
Mailing Address - Street 1:1554 BASIL ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36603-5019
Mailing Address - Country:US
Mailing Address - Phone:251-652-3658
Mailing Address - Fax:251-415-2055
Practice Address - Street 1:1554 BASIL STREET
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603
Practice Address - Country:US
Practice Address - Phone:251-652-3658
Practice Address - Fax:251-415-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care