Provider Demographics
NPI:1699386789
Name:ELITE MULTI SPECIALTY CLINIC, LLC
Entity Type:Organization
Organization Name:ELITE MULTI SPECIALTY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ADAORA
Authorized Official - Middle Name:PERPETUA
Authorized Official - Last Name:NOUMMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-592-1780
Mailing Address - Street 1:12501 PROSPERITY DR STE 330
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1655
Mailing Address - Country:US
Mailing Address - Phone:301-592-1780
Mailing Address - Fax:240-645-4013
Practice Address - Street 1:12501 PROSPERITY DR STE 330
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1655
Practice Address - Country:US
Practice Address - Phone:301-592-1780
Practice Address - Fax:240-645-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1053758235OtherNPPES