Provider Demographics
NPI:1407522113
Name:ELITE MOBILE HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:ELITE MOBILE HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:501-298-7145
Mailing Address - Street 1:8003 MAURICE RD APT B
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-1640
Mailing Address - Country:US
Mailing Address - Phone:501-298-7145
Mailing Address - Fax:
Practice Address - Street 1:8003 MAURICE RD APT B
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-1640
Practice Address - Country:US
Practice Address - Phone:501-298-7145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty