Provider Demographics
NPI:1760154710
Name:ELITE AESTHETICS & MEDICAL CARE, LLC
Entity Type:Organization
Organization Name:ELITE AESTHETICS & MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:740-441-5156
Mailing Address - Street 1:24 STAR DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9845
Mailing Address - Country:US
Mailing Address - Phone:740-851-4599
Mailing Address - Fax:
Practice Address - Street 1:24 STAR DR UNIT B
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9845
Practice Address - Country:US
Practice Address - Phone:740-851-4599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center