Provider Demographics
NPI:1821613076
Name:ELITE CAREGIVER LLC
Entity Type:Organization
Organization Name:ELITE CAREGIVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABDULMATEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADELAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-745-7908
Mailing Address - Street 1:18126 SONORA BROOK LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1808
Mailing Address - Country:US
Mailing Address - Phone:832-757-7149
Mailing Address - Fax:
Practice Address - Street 1:18126 SONORA BROOK LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1808
Practice Address - Country:US
Practice Address - Phone:832-757-7149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-13
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX521853602Medicaid