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General NPI Number Information
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NPI Number | 1639373988
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Entity Type | Organization
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Legal Business Name | ELITE CARE INC.
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 12/13/2017
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Provider Practice Location Address
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Address Line | 103 KILLDEER CT
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City | SOUTHLAKE
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State | TX
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Zip | 76092-5802
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Country | US
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Telephone | 817-223-4638
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Fax | 817-488-9252
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Provider Business Mailing Address
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Address Line | PO BOX 11295
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City | FORT WORTH
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State | TX
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Zip | 76110-0295
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Country | US
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Telephone | 817-454-0691
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Fax | 817-507-3491
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MRS. TAMMIE WYNELL RICHARDSON HUGHES
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Credential |
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Telephone | 817-454-0691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 001008162
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License Number State | TX
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