Provider Demographics
NPI:1972752392
Name:ELITE HOUSES OF SOBER LIVING,INC.
Entity Type:Organization
Organization Name:ELITE HOUSES OF SOBER LIVING,INC.
Other - Org Name:ELITE TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:III
Authorized Official - Credentials:CADC; NCRS;MISA 1
Authorized Official - Phone:312-515-3092
Mailing Address - Street 1:395 W LINCOLN HWY
Mailing Address - Street 2:PO. BOX 2122
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-2442
Mailing Address - Country:US
Mailing Address - Phone:708-755-5117
Mailing Address - Fax:708-755-5404
Practice Address - Street 1:395 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-2442
Practice Address - Country:US
Practice Address - Phone:708-755-5117
Practice Address - Fax:708-755-5404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE HOUSES OF SOBER LIVING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-4780-00055-A251S00000X
ILA-4780-0005-A261QA3000X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QA3000XAmbulatory Health Care FacilitiesClinic/CenterAugmentative Communication
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health