Provider Demographics
NPI:1255149860
Name:ELITE HOME CARE DAY CARE AND TRAINING
Entity type:Organization
Organization Name:ELITE HOME CARE DAY CARE AND TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:POTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-269-1487
Mailing Address - Street 1:13314 CRANWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16004 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2575
Practice Address - Country:US
Practice Address - Phone:216-269-1487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services