Provider Demographics
NPI:1689448540
Name:ELITE STAR THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:ELITE STAR THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAMLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-231-7727
Mailing Address - Street 1:4421 DIXIE HILL RD APT 409
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-9080
Mailing Address - Country:US
Mailing Address - Phone:703-231-7727
Mailing Address - Fax:
Practice Address - Street 1:4421 DIXIE HILL RD APT 409
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-9080
Practice Address - Country:US
Practice Address - Phone:703-231-7727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health