| Elite Care Service Inc. | |
|
111 Lamon St Suite 100 Fayetteville NC 28301-4901 | |
| (910) 483-0324 | |
| (910) 483-2246 |
| Full Name | Elite Care Service Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 111 Lamon St, Fayetteville, North Carolina |
| Authorized Official Name and Position | Kevin Coaxum (CEO) |
| Authorized Official Contact | 9104830324 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Care Service Inc. Po Box 9525 Fayetteville NC 28311-9088 Ph: (910) 483-0324 | Elite Care Service Inc. 111 Lamon St Suite 100 Fayetteville NC 28301-4901 Ph: (910) 483-0324 |
| NPI Number | 1417135500 |
|---|---|
| Provider Enumeration Date | 01/31/2008 |
| Last Update Date | 05/20/2022 |
| Certification Date | 05/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417135500 | NPI | - | NPPES |
| 00112912 | Medicaid | NC |
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