Provider Demographics
NPI:1760162481
Name:ELITE CARE WELLNESS LLC
Entity Type:Organization
Organization Name:ELITE CARE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MOITALEL
Authorized Official - Last Name:MUNKA
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:818-429-6550
Mailing Address - Street 1:3826 S 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-0133
Mailing Address - Country:US
Mailing Address - Phone:174-735-6155
Mailing Address - Fax:
Practice Address - Street 1:4040 E MCDOWELL RD STE 418
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4448
Practice Address - Country:US
Practice Address - Phone:818-429-6550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service