ELITE RESIDENTIAL, LLC (NPI# 1760904338) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760904338 |
| Entity Type | Organization |
| Organization Name | ELITE RESIDENTIAL, LLC |
| Practice Address |
1554 Basil Street Mobile AL 36603 |
| Mailing Address |
1554 Basil St Mobile AL 36603-5019 |
| Practice Telephone | (251) 652-3658 |
| Practice Fax Number | 2514152055 |
| Mailing Telephone | 2516523658 |
| Mailing Fax Number | 2514152055 |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2017-07-14 |
| Authorized Official Name | MS. ERICKA LETOINDIA BETTON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2513678634 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities | ||
| N | 385H00000X | Respite Care | Respite Care Facility | ||
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Street Address |
1554 BASIL STREET |
| City | MOBILE |
| State | AL |
| Zip Code | 36603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457813412 | Vanessa Gill | Home Health | 916 State St., Same As Above, Mobile, AL 36603 | 2019-04-01 |
| 1942784483 | Dale Deward Donnelly | Physical Therapy Assistant | 1361 Dr. Martin Luther King Jr. Ave., Mobile, AL 36603 | 2018-09-20 |
| 1699195024 | Jamie Hennigan | Student in an Organized Health Care Education/Training Program | 162.5 N Bayou St, Upper B, Mobile, AL 36603 | 2014-04-24 |
| 1487747945 | Beverly A Wilson | Dentist | 1303 Dr. Martin L King Jr Ave, Mobile, AL 36603 | 2006-10-02 |
| 1679532303 | Franklin Primary Health Center, Inc. | Obstetrics & Gynecology | 1303 Dr Martin L King Jr Ave, Mobile, AL 36603 | 2006-03-21 |
| 1871936641 | Leticia M Gibbs | Nurse Practitioner | 251 N Bayou St, Mobile, AL 36603 | 2013-04-11 |
| 1669657896 | James M Lawrence | Family Medicine | 1303 Dr Martin L King Jr Ave, Mobile, AL 36603 | 2008-01-07 |
| 1417913682 | Montubua Vasser-smith | Internal Medicine | 1303 Dr Martin Luther King Jr Ave, Mobile, AL 36603 | 2006-04-25 |
| 1851356760 | Gail Anita Luker | Nurse Practitioner | 1303 Dr Martin L King Jr Ave, Mobile Center Franklin Primary Health Center Inc, Mobile, AL 36603 | 2006-04-20 |
| 1003896358 | Angelia Deniese Lewis | Nurse Practitioner | 251 N Bayou St, Mobile, AL 36603 | 2006-01-20 |
| Find all providers in zip 36603 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972021970 | Volunteers of America Southeast | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1204 Hillcrest Rd, Mobile, AL 36695-3930 | 2017-08-30 |
| 1851813422 | Ericka Letoindia Betton | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1554 Basil St, Mobile, AL 36603-5019 | 2017-07-14 |
| 1275945149 | George Lee Love | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 13321 August Dr, Mobile, AL 36695-8595 | 2014-05-27 |
| 1063838878 | Shirley Mcmillan Jackson | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2117 Luckner Ct, Mobile, AL 36618-2618 | 2014-03-17 |
| 1477975936 | Prestige Supervised Community Living Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1725 Northview Dr, Mobile, AL 36618-1801 | 2014-01-16 |
| 1992090666 | Robinson's Residential, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4954 Ringold Dr S, Mobile, AL 36693-3678 | 2011-06-10 |
| 1871885517 | Lifetime Healthcare Incorporated | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2201 Robinson Dr, Mobile, AL 36605-5137 | 2011-05-13 |
| 1518280668 | Northview Health Services, L.l.c | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1640 Northview Dr, Mobile, AL 36618-1804 | 2010-03-03 |
| 1063549103 | Parker Adult Foster Home, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 671 Stanton Rd, Mobile, AL 36617-2205 | 2007-02-27 |
| 1952437493 | Nobles Group Homes, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2420 S Shelton Beach Rd, Mobile, AL 36613-3415 | 2007-02-27 |
| Find all providers in MOBILE | ||||
Please comment or provide details below to improve the information on ELITE RESIDENTIAL, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.