Provider Demographics
NPI:1871221549
Name:ELITE CASE MANAGEMENT AGENCY LLC
Entity type:Organization
Organization Name:ELITE CASE MANAGEMENT AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNO
Authorized Official - Prefix:
Authorized Official - First Name:LATOSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-863-0258
Mailing Address - Street 1:409 BALD CYPRESS CV
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-6002
Mailing Address - Country:US
Mailing Address - Phone:601-863-0258
Mailing Address - Fax:601-586-5693
Practice Address - Street 1:1700 UNIVERSITY BLVD STE 8
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3907
Practice Address - Country:US
Practice Address - Phone:601-863-0258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty