Healthcare Provider Details

I. General information

NPI: 1174098081
Provider Name (Legal Business Name): ELITE THERAPY SOLUTIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2018
Last Update Date: 10/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 159TH ST STE 400
OAK FOREST IL
60452-3334
US

IV. Provider business mailing address

15128 S LA GRANGE RD UNIT 2694
ORLAND PARK IL
60462-8530
US

V. Phone/Fax

Practice location:
  • Phone: 773-387-1477
  • Fax:
Mailing address:
  • Phone: 773-387-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: EDWARD WHITTAKER
Title or Position: VP
Credential:
Phone: 773-387-1477