Provider Demographics
NPI:1417539743
Name:ELITE WELLNESS SERVICES, LLC
Entity Type:Organization
Organization Name:ELITE WELLNESS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEM
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:CLAVIJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-467-8634
Mailing Address - Street 1:12905 SW 42ND ST STE 207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12905 SW 42ND ST STE 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2912
Practice Address - Country:US
Practice Address - Phone:305-467-8634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty