Healthcare Provider Details

I. General information

NPI: 1609700178
Provider Name (Legal Business Name): ELITE CARE RESIDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11451 LAKEPOINTE ST
DETROIT MI
48224-1607
US

IV. Provider business mailing address

47352 CHERRY VALLEY DR
MACOMB MI
48044-5904
US

V. Phone/Fax

Practice location:
  • Phone: 313-729-0021
  • Fax:
Mailing address:
  • Phone: 313-729-0021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LAGONIA ROGERS
Title or Position: OWNER
Credential:
Phone: 313-729-0021