Provider Demographics
NPI:1174865109
Name:ELITE HEALTHCARE CENTER PA
Entity Type:Organization
Organization Name:ELITE HEALTHCARE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGLADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-629-7267
Mailing Address - Street 1:876 W SUGARLAND HWY
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-2704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:876 W SUGARLAND HWY
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-2704
Practice Address - Country:US
Practice Address - Phone:561-629-7267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty