Healthcare Provider Details

I. General information

NPI: 1194513317
Provider Name (Legal Business Name): ELITE MULTISERVICE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 JAMES ST
ORANGE PARK FL
32073-4225
US

IV. Provider business mailing address

319 JAMES ST
ORANGE PARK FL
32073-4225
US

V. Phone/Fax

Practice location:
  • Phone: 855-362-2025
  • Fax:
Mailing address:
  • Phone: 855-362-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN PIERRE
Title or Position: AMBR
Credential:
Phone: 954-512-7810