Provider Demographics
NPI:1790221422
Name:ELITE TRANSPO
Entity Type:Organization
Organization Name:ELITE TRANSPO
Other - Org Name:ETN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DRAE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-639-7954
Mailing Address - Street 1:2019 BURFOOT ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-1346
Mailing Address - Country:US
Mailing Address - Phone:703-639-7954
Mailing Address - Fax:815-642-4231
Practice Address - Street 1:2019 BURFOOT ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-1346
Practice Address - Country:US
Practice Address - Phone:703-639-7954
Practice Address - Fax:815-642-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA08128654343900000X, 344800000X, 347C00000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344800000XTransportation ServicesAir Carrier
No347E00000XTransportation ServicesTransportation Broker