Healthcare Provider Details

I. General information

NPI: 1558986976
Provider Name (Legal Business Name): ELITE TREATMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W LINCOLN HWY
CHICAGO HEIGHTS IL
60411-2442
US

IV. Provider business mailing address

395 W LINCOLN HWY
CHICAGO HEIGHTS IL
60411-2442
US

V. Phone/Fax

Practice location:
  • Phone: 773-597-7698
  • Fax:
Mailing address:
  • Phone: 773-597-7698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE ELLIS
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 708-781-3155