Provider Demographics
NPI:1669997839
Name:ELITE HEALTHCARE LLC
Entity type:Organization
Organization Name:ELITE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NATIVIDAD
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-639-0548
Mailing Address - Street 1:1905 MCDANIEL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7170
Mailing Address - Country:US
Mailing Address - Phone:702-639-0548
Mailing Address - Fax:702-639-0735
Practice Address - Street 1:1905 MCDANIEL ST STE 102
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7170
Practice Address - Country:US
Practice Address - Phone:702-639-0548
Practice Address - Fax:702-639-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty