Provider Demographics
NPI:1457005233
Name:ELITE HOLDINGS & ASSOCIATES
Entity Type:Organization
Organization Name:ELITE HOLDINGS & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-906-6779
Mailing Address - Street 1:205 HIGHLAND PL
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2015
Mailing Address - Country:US
Mailing Address - Phone:310-906-6779
Mailing Address - Fax:
Practice Address - Street 1:205 HIGHLAND PL
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2015
Practice Address - Country:US
Practice Address - Phone:310-906-6779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA