Healthcare Provider Details

I. General information

NPI: 1083520977
Provider Name (Legal Business Name): ELITE HEALTHCARE TRAINING ACADEMY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N EASTERN BLVD
MONTGOMERY AL
36117-2213
US

IV. Provider business mailing address

555 N EASTERN BLVD
MONTGOMERY AL
36117-2213
US

V. Phone/Fax

Practice location:
  • Phone: 334-766-0009
  • Fax: 334-676-1499
Mailing address:
  • Phone: 334-766-0009
  • Fax: 334-676-1499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: LAKESHIA BROWN
Title or Position: DIRECTOR
Credential: BSN-RN
Phone: 334-766-0009