Provider Demographics
NPI:1073295341
Name:ELITE CARE THERAPEUTICS, LLC
Entity Type:Organization
Organization Name:ELITE CARE THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRY
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:978-514-0747
Mailing Address - Street 1:525 MASS AVE
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2959
Mailing Address - Country:US
Mailing Address - Phone:978-514-0747
Mailing Address - Fax:
Practice Address - Street 1:525 MASS AVE
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-2959
Practice Address - Country:US
Practice Address - Phone:978-514-0747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty