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General NPI Number Information
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NPI Number | 1326412578
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Entity Type | Organization
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Legal Business Name | ELITE ADOLESCENT CARE, INC.
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Dates
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Enumeration Date | 11/25/2015
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Last Update Date | 05/06/2016
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Provider Practice Location Address
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Address Line | 4501 OLD BATTLEGROUND RD
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City | GREENSBORO
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State | NC
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Zip | 27410-9352
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Country | US
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Telephone | 336-763-7287
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 38338
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City | GREENSBORO
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State | NC
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Zip | 27408-8338
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Country | US
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Telephone | 336-763-7287
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MICHAEL A. CAMPI
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Credential |
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Telephone | 843-729-6072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | MHL-041-1082
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License Number State | NC
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