Provider Demographics
NPI:1578185104
Name:ELITE SUPPLY SERVICES, INC.
Entity Type:Organization
Organization Name:ELITE SUPPLY SERVICES, INC.
Other - Org Name:ELITE GROUP WARREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:SOUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:910-978-9118
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-0417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:910-248-6258
Practice Address - Street 1:2148 BUS-US 401
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376
Practice Address - Country:US
Practice Address - Phone:910-565-2857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2023-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)