ELGREAT HEALTHCARE SERVICES LLC

Provider Demographics

• NPI: 1922753193
• Name: ELGREAT HEALTHCARE SERVICES LLC
• Entity Type: Organization
• Organization Name: ELGREAT HEALTHCARE SERVICES LLC
• Other - Org Name: ELGREAT HEALTHCARE CENTER
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: ADMINISTRATOR
• Authorized Official - First Name: IFEOMA
• Authorized Official - Middle Name: NKEMDILIM JENNIFER
• Authorized Official - Last Name: ELEBO
• Authorized Official - Credentials: FNP
• Authorized Official - Phone: 804-528-9752
• Mailing Address - Street 1: 2301 HILLIARD RD STE 4
• Mailing Address - City: HENRICO
• Mailing Address - State: VA
• Mailing Address - Zip Code: 23228-4525
• Mailing Address - Country: US
• Mailing Address - Phone: 804-528-9752
• Mailing Address - Fax: 804-409-8005
• Practice Address - Street 1: 2301 HILLIARD RD STE 4
• Practice Address - City: HENRICO
• Practice Address - State: VA
• Practice Address - Zip Code: 23228-4525
• Practice Address - Country: US
• Practice Address - Phone: 804-528-9752
• Practice Address - Fax: 804-409-8005
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2022-02-16
• Last Update Date: 2023-05-01

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261QM1300X	Ambulatory Health Care Facilities	Clinic/Center	Multi-Specialty
No	261QM0801X	Ambulatory Health Care Facilities	Clinic/Center	Mental Health (Including Community Mental Health Center)
No	261QP2300X	Ambulatory Health Care Facilities	Clinic/Center	Primary Care
No	261QR0405X	Ambulatory Health Care Facilities	Clinic/Center	Rehabilitation, Substance Use Disorder	Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	363LP0200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Pediatrics	Group - Multi-Specialty
No	363LP0808X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Psychiatric/Mental Health	Group - Multi-Specialty
No	363LP2300X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Primary Care	Group - Multi-Specialty
No	363LW0102X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Women's Health	Group - Multi-Specialty