Provider Demographics
NPI:1497406128
Name:ELITE CARE AND MANAGEMENT SERVICES
Entity type:Organization
Organization Name:ELITE CARE AND MANAGEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RIVETTE
Authorized Official - Middle Name:N
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:910-758-3488
Mailing Address - Street 1:2132 YELLOWBRICK RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-8536
Mailing Address - Country:US
Mailing Address - Phone:910-758-3488
Mailing Address - Fax:
Practice Address - Street 1:111 LAMON ST STE 100
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4917
Practice Address - Country:US
Practice Address - Phone:910-483-0324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness