MEDICARE: ELITES CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	320800000X	Mental Illness Community Based Residential Treatment Facility
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1093309015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITES CARE, LLC

Provider Business Mailing Address
First Line	:	6911 RICHMOND HWY STE 302
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1846
Country	:	US
Telephone Number	:	703-660-9101
Fax Number	:

Provider Business Practice Location Address
First Line	:	6911 RICHMOND HWY STE 302
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1846
Country	:	US
Telephone Number	:	703-660-9101
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	AWONTI ETOO NDJONGO
Credential	:
Telephone Number	:	703-660-9101

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	02/22/2021

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Directions to “ELITES CARE, LLC ” Practice Location

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