MEDICARE: ELITE OF CARE SERVICES, 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	305R00000X	Preferred Provider Organization		MI
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		MI

General Provider Information

NPI Number	:	1942307590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE OF CARE SERVICES, INC

Provider Business Mailing Address
First Line	:	15442 OAKFIELD ST
Second Line	:	P.O.BOX 32988
City	:	DETROIT
State	:	MI
Zip	:	48227-1534
Country	:	US
Telephone Number	:	313-659-9030
Fax Number	:	313-271-8411

Provider Business Practice Location Address
First Line	:	15442 OAKFIELD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-1534
Country	:	US
Telephone Number	:	313-659-9030
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. NICHOLE AULEASE LANDERS
Credential	:	SOCIAL WORKER
Telephone Number	:	313-384-0790

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	09/11/2025

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