Organization
ELITE RESIDENTIAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ERICKA LETOINDIA BETTON (EXECUTIVE DIRECTOR)
(251) 367-8634
Entity
Organization
Contact information
Practice address
1554 BASIL STREET, MOBILE, AL 36603
(251) 652-3658
(251) 415-2055
Mailing address
1554 BASIL ST, MOBILE, AL 36603-5019
(251) 652-3658
(251) 415-2055
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
07/14/2017
Last updated
07/21/2022
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