Elite Residential for Matured Adults

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

Legal business name

ELITE RESIDENTIAL FOR MATURED ADULTS

Practice address

160 Wilson Dr
Prosper, TX 75078-8580

Phone

(972) 347-6035

Fax

(972) 347-6250

NPI assigned

Oct 8, 2008

Last updated

Oct 8, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Vikkilynn Prevost, R.D.H

Title

Co-Owner/Director

Phone

(972) 347-6035

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223424000000",
    "number": "1083865141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 WILSON DR",
            "city": "PROSPER",
            "state": "TX",
            "postal_code": "750788580",
            "telephone_number": "972-347-6035",
            "fax_number": "972-347-6250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 WILSON DR",
            "city": "PROSPER",
            "state": "TX",
            "postal_code": "750788580",
            "telephone_number": "972-347-6035",
            "fax_number": "972-347-6250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE RESIDENTIAL FOR MATURED ADULTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-08",
        "last_updated": "2008-10-08",
        "status": "A",
        "authorized_official_last_name": "PREVOST",
        "authorized_official_first_name": "VIKKILYNN",
        "authorized_official_title_or_position": "CO-OWNER/DIRECTOR",
        "authorized_official_telephone_number": "972-347-6035",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "R.D.H"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Disabilities Residential Treatment Facility in Prosper, TX
• Providers in Prosper, TX by specialty
• Physical Disabilities Residential Treatment Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.