Provider Demographics
NPI:1245006022
Name:ELITE COMPLETE CARE LLC
Entity type:Organization
Organization Name:ELITE COMPLETE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:TUPERE
Authorized Official - Last Name:KISHOIYIAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:321-948-6674
Mailing Address - Street 1:PO BOX 770843
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32877-0843
Mailing Address - Country:US
Mailing Address - Phone:321-948-6674
Mailing Address - Fax:
Practice Address - Street 1:1425 DARNABY WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-5073
Practice Address - Country:US
Practice Address - Phone:321-948-6674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty