Provider Demographics
NPI:1649410887
Name:ELITE FITNESS INSTITUTE, INC.
Entity Type:Organization
Organization Name:ELITE FITNESS INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:847-634-0400
Mailing Address - Street 1:555 CORPORATE WOODS PKWY
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-3111
Mailing Address - Country:US
Mailing Address - Phone:847-634-0400
Mailing Address - Fax:847-634-2900
Practice Address - Street 1:555 CORPORATE WOODS PKWY
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-3111
Practice Address - Country:US
Practice Address - Phone:847-634-0400
Practice Address - Fax:847-634-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-28
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096001765305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization