Provider Demographics
NPI:1851989420
Name:ELITE CARE PSA LLC
Entity Type:Organization
Organization Name:ELITE CARE PSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTRANGELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-505-3623
Mailing Address - Street 1:568 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6843
Mailing Address - Country:US
Mailing Address - Phone:630-548-9500
Mailing Address - Fax:630-548-0541
Practice Address - Street 1:250 W 80TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5430
Practice Address - Country:US
Practice Address - Phone:219-648-2125
Practice Address - Fax:219-472-8468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care