Healthcare Provider Details

I. General information

NPI: 1033944210
Provider Name (Legal Business Name): ELITE CARE COMMUNITY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14411 COMMERCE WAY STE 310
MIAMI LAKES FL
33016-1532
US

IV. Provider business mailing address

14411 COMMERCE WAY STE 310
MIAMI LAKES FL
33016-1532
US

V. Phone/Fax

Practice location:
  • Phone: 786-474-1134
  • Fax:
Mailing address:
  • Phone: 786-474-1134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ARIAN MORALES CARRILLO
Title or Position: PRESIDENT
Credential:
Phone: 786-474-1134