Healthcare Provider Details

I. General information

NPI: 1912373440
Provider Name (Legal Business Name): ELITE CITY TRANSIT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11031 S KING DR UNIT 2W
CHICAGO IL
60628-4462
US

IV. Provider business mailing address

11031 S KING DR UNIT 2W
CHICAGO IL
60628-4462
US

V. Phone/Fax

Practice location:
  • Phone: 773-209-9344
  • Fax:
Mailing address:
  • Phone: 773-209-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberM60054084727
License Number StateIL

VIII. Authorized Official

Name: MESHAUN MOORE
Title or Position: CEO
Credential:
Phone: 773-209-9344