Provider Demographics
NPI:1548710023
Name:ELITE CARE
Entity type:Organization
Organization Name:ELITE CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUBSTAMCE ABUSE
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FERNANDORUS
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSA-A
Authorized Official - Phone:910-261-0941
Mailing Address - Street 1:722 SAGE ST
Mailing Address - Street 2:722
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312
Mailing Address - Country:US
Mailing Address - Phone:910-261-0941
Mailing Address - Fax:
Practice Address - Street 1:111 LAMON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301
Practice Address - Country:US
Practice Address - Phone:910-483-0324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITECARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management