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General NPI Number Information
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NPI Number | 1215868682
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Entity Type | Organization
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Legal Business Name | ELITE CARE GH 1 LLC
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Dates
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Enumeration Date | 05/26/2026
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Last Update Date | 05/26/2026
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Provider Practice Location Address
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Address Line | 4801 WATAUGA RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3227
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Country | US
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Telephone | 732-674-5748
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9525
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-9088
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Country | US
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Telephone | 732-674-5748
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JAMES FREDERICK
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Credential |
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Telephone | 732-674-5748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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