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General NPI Number Information
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NPI Number | 1356216774
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Entity Type | Organization
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Legal Business Name | ELITE AFC III LLC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 2120 BRADLEY AVE
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City | YPSILANTI
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State | MI
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Zip | 48198-9233
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Country | US
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Telephone | 734-340-2112
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 701160
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City | PLYMOUTH
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State | MI
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Zip | 48170-0960
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Country | US
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Telephone | 973-955-7825
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Fax | 269-883-9353
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Authorized Official
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Title or Position | DIRECTOR
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Name | LARA SALEH
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Credential |
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Telephone | 973-955-7825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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