Healthcare Provider Details

I. General information

NPI: 1790699809
Provider Name (Legal Business Name): SAPPHIRE ELITE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10029 S CALUMET AVE
CHICAGO IL
60628-2121
US

IV. Provider business mailing address

1655 S BLUE ISLAND AVE # 481
CHICAGO IL
60608-2133
US

V. Phone/Fax

Practice location:
  • Phone: 872-387-2041
  • Fax:
Mailing address:
  • Phone: 872-387-2041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL

VIII. Authorized Official

Name: KENNETH PAYNE
Title or Position: OWNER
Credential:
Phone: 708-893-1356