Provider Demographics
NPI:1083740674
Name:ELITE MEDSERVE, INC.
Entity Type:Organization
Organization Name:ELITE MEDSERVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHIKENYEM
Authorized Official - Middle Name:NDDY
Authorized Official - Last Name:OKOLIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-987-9000
Mailing Address - Street 1:6917 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77033-1919
Mailing Address - Country:US
Mailing Address - Phone:713-987-9000
Mailing Address - Fax:713-987-9011
Practice Address - Street 1:6917 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-1919
Practice Address - Country:US
Practice Address - Phone:713-987-9000
Practice Address - Fax:713-987-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120309261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care