MEDICARE: ELITE ADOLESCENT CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TC2200X	Clinical Child & Adolescent Psychologist
3	103TB0200X	Cognitive & Behavioral Psychologist
4	104100000X	Social Worker
5	101YS0200X	School Counselor
6	103TM1800X	Intellectual & Developmental Disabilities Psychologist
7	1041S0200X	School Social Worker
8	251S00000X	Community/Behavioral Health Agency
9	323P00000X	Psychiatric Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235401811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE ADOLESCENT CARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 38338
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-8338
Country	:	US
Telephone Number	:	336-763-7287
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 OLD BATTLEGROUND RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-9352
Country	:	US
Telephone Number	:	910-483-0324
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. AVERY B. GREEN
Credential	:
Telephone Number	:	336-763-7287

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	12/16/2015

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Directions to “ELITE ADOLESCENT CARE, INC. ” Practice Location

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