Provider Demographics
NPI:1356667489
Name:ELITE CARE PROVIDERS PC
Entity Type:Organization
Organization Name:ELITE CARE PROVIDERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONAS
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:217-418-0118
Mailing Address - Street 1:704 GOLDENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-3430
Mailing Address - Country:US
Mailing Address - Phone:217-418-0118
Mailing Address - Fax:
Practice Address - Street 1:704 GOLDENVIEW DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-3430
Practice Address - Country:US
Practice Address - Phone:217-418-0118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty