Healthcare Provider Details

I. General information

NPI: 1003747130
Provider Name (Legal Business Name): ELITE CARE GH2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 LANSFORD DR
FAYETTEVILLE NC
28314-2052
US

IV. Provider business mailing address

PO BOX 9525
FAYETTEVILLE NC
28311-9088
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-0324
  • Fax:
Mailing address:
  • Phone: 732-674-5748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JAMES FREDERICK
Title or Position: CEO
Credential:
Phone: 732-674-5748