Provider Demographics
NPI:1255877122
Name:ELITE REHAB NOLA
Entity type:Organization
Organization Name:ELITE REHAB NOLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-469-5011
Mailing Address - Street 1:220 ROYAL CRESCENT TER
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-1837
Mailing Address - Country:US
Mailing Address - Phone:678-469-5011
Mailing Address - Fax:
Practice Address - Street 1:2404 EDENBORN AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1817
Practice Address - Country:US
Practice Address - Phone:504-833-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty