Provider Demographics
NPI:1255867099
Name:ELITE WELLNESS & HEALTHCARE
Entity Type:Organization
Organization Name:ELITE WELLNESS & HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAKEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-824-5728
Mailing Address - Street 1:3118 FORRESTAL DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-4782
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3118 FORRESTAL DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-4782
Practice Address - Country:US
Practice Address - Phone:919-824-5728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health