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General NPI Number Information
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NPI Number | 1710686811
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Entity Type | Organization
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Legal Business Name | ELITE CARE SERVICES LLC
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 14649 230TH ST
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City | SPRINGFIELD GARDENS
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State | NY
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Zip | 11413-4423
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Country | US
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Telephone | 718-200-9384
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Fax |
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Provider Business Mailing Address
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Address Line | 14649 230TH ST
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City | SPRINGFIELD GARDENS
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State | NY
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Zip | 11413-4423
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANNON SEDONIA BUTLER-STEWART
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Credential |
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Telephone | 718-722-1451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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