Provider Demographics
NPI:1518714310
Name:ELITE LONG TERM CARE PLLC
Entity type:Organization
Organization Name:ELITE LONG TERM CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WIDAD
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:YOUSIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-977-9066
Mailing Address - Street 1:34580 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5277
Mailing Address - Country:US
Mailing Address - Phone:586-977-9066
Mailing Address - Fax:586-977-9041
Practice Address - Street 1:34580 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5277
Practice Address - Country:US
Practice Address - Phone:586-977-9066
Practice Address - Fax:586-977-9041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE INTERNAL MEDICINE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty