Provider Demographics
NPI:1013671502
Name:ELITE DIAGNOSTICS LABORATORIES LLC
Entity Type:Organization
Organization Name:ELITE DIAGNOSTICS LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALREFAE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:708-475-1441
Mailing Address - Street 1:3540 SEVEN BRIDGES DR STE 130
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1222
Mailing Address - Country:US
Mailing Address - Phone:630-541-8680
Mailing Address - Fax:630-541-8595
Practice Address - Street 1:3540 SEVEN BRIDGES DR STE 130
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1222
Practice Address - Country:US
Practice Address - Phone:630-541-8680
Practice Address - Fax:630-541-8595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory