Provider Demographics
NPI:1881831956
Name:ELITE THERAPEUTICS AND HEALTHCARE, INC
Entity Type:Organization
Organization Name:ELITE THERAPEUTICS AND HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:VIZCAYNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-409-6643
Mailing Address - Street 1:536 W DAYBREAK LN
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5696
Mailing Address - Country:US
Mailing Address - Phone:847-409-6643
Mailing Address - Fax:224-338-0515
Practice Address - Street 1:536 W DAYBREAK LN
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-5696
Practice Address - Country:US
Practice Address - Phone:847-409-6643
Practice Address - Fax:224-338-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty