Healthcare Provider Details

I. General information

NPI: 1558100628
Provider Name (Legal Business Name): ELITE TRAINING SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E MCKELLIPS RD STE 5
MESA AZ
85203-2739
US

IV. Provider business mailing address

1350 E MCKELLIPS RD STE 5
MESA AZ
85203-2739
US

V. Phone/Fax

Practice location:
  • Phone: 602-969-3469
  • Fax:
Mailing address:
  • Phone: 480-647-2169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: HAZEL D PARKES
Title or Position: OWNER
Credential:
Phone: 602-969-3469