Provider Demographics
NPI:1639355886
Name:ELITE LIFE SOLUTIONS LLC
Entity type:Organization
Organization Name:ELITE LIFE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-491-8539
Mailing Address - Street 1:703 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1047
Mailing Address - Country:US
Mailing Address - Phone:801-491-8539
Mailing Address - Fax:801-491-8540
Practice Address - Street 1:703 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1047
Practice Address - Country:US
Practice Address - Phone:801-491-8539
Practice Address - Fax:801-491-8540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6135660001Medicare NSC