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General NPI Number Information
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NPI Number | 1962650507
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Entity Type | Organization
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Legal Business Name | ELITE PROFESSINAL SERVICES, LLC
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Dates
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Enumeration Date | 09/08/2008
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Last Update Date | 09/08/2008
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Provider Practice Location Address
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Address Line | 119 E WATER ST
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City | PLYMOUTH
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State | NC
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Zip | 27962-1300
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Country | US
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Telephone | 252-793-9991
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Fax | 252-793-9991
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Provider Business Mailing Address
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Address Line | 119 E WATER ST
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City | PLYMOUTH
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State | NC
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Zip | 27962-1300
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Country | US
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Telephone | 252-793-9991
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Fax | 252-793-9991
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Authorized Official
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Title or Position | CEO
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Name | MS. DEVITA RENAE PHELPS
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Credential |
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Telephone | 252-793-9991
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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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