Provider Demographics
NPI:1003307307
Name:ELITE TECHNICAL CARE LLC
Entity Type:Organization
Organization Name:ELITE TECHNICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-319-8924
Mailing Address - Street 1:27789 MOUND RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2900
Mailing Address - Country:US
Mailing Address - Phone:844-512-6609
Mailing Address - Fax:
Practice Address - Street 1:27789 MOUND RD STE 400
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2900
Practice Address - Country:US
Practice Address - Phone:844-512-6609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI812968125OtherBLUE CROSS BLUE SHIELD