MEDICARE: ELITE BEHAVIORAL, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821577206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE BEHAVIORAL, INC.

Provider Business Mailing Address
First Line	:	8074 NW 103RD ST STE 2
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2256
Country	:	US
Telephone Number	:	305-209-4190
Fax Number	:	305-508-4302

Provider Business Practice Location Address
First Line	:	8074 NW 103RD ST STE 2
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2256
Country	:	US
Telephone Number	:	305-209-4190
Fax Number	:	305-508-4302

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	RAUL LUZARDO
Credential	:
Telephone Number	:	305-209-4190

Provider Enumeration Date	:	08/07/2018
Last Update Date	:	06/18/2019

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