Provider Demographics
NPI:1700388048
Name:ELITE INNOVATIONS, LLC
Entity Type:Organization
Organization Name:ELITE INNOVATIONS, LLC
Other - Org Name:STELLAR TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-999-9998
Mailing Address - Street 1:6039 CYPRESS GARDENS BLVD STE 533
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-4115
Mailing Address - Country:US
Mailing Address - Phone:863-999-9998
Mailing Address - Fax:863-999-9998
Practice Address - Street 1:3630 HAVENDALE BLVD NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-1063
Practice Address - Country:US
Practice Address - Phone:863-999-9998
Practice Address - Fax:863-999-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty