Provider Demographics
NPI:1831547769
Name:ELITE LOGICARE GROUP
Entity type:Organization
Organization Name:ELITE LOGICARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEONCINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OUAYORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-276-1624
Mailing Address - Street 1:11325 RANDOM HILLS RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6051
Mailing Address - Country:US
Mailing Address - Phone:703-225-3479
Mailing Address - Fax:703-225-3333
Practice Address - Street 1:11325 RANDOM HILLS RD
Practice Address - Street 2:SUITE 360
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6051
Practice Address - Country:US
Practice Address - Phone:703-225-3479
Practice Address - Fax:703-225-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA469343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)