Healthcare Provider Details

I. General information

NPI: 1023797420
Provider Name (Legal Business Name): ELITE INTEGRATED HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 GANTTOWN RD STE 103
SEWELL NJ
08080-1895
US

IV. Provider business mailing address

521 SICKLERVILLE RD STE 3
SICKLERVILLE NJ
08081-2636
US

V. Phone/Fax

Practice location:
  • Phone: 856-965-1000
  • Fax:
Mailing address:
  • Phone: 856-956-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAFIA NICOLA GROOMS
Title or Position: OWNER
Credential: DNP
Phone: 856-956-1000