Healthcare Provider Details

I. General information

NPI: 1114749033
Provider Name (Legal Business Name): ELITE HOLISTIC CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 E UNION HILLS DR
PHOENIX AZ
85050-3430
US

IV. Provider business mailing address

2906 E UNION HILLS DR
PHOENIX AZ
85050-3430
US

V. Phone/Fax

Practice location:
  • Phone: 602-699-4536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE PINLAC
Title or Position: MEMBER/ PROVIDER
Credential: NP
Phone: 602-699-4536