Healthcare Provider Details

I. General information

NPI: 1083740674
Provider Name (Legal Business Name): ELITE MEDSERVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 MARTIN LUTHER KING BLVD
HOUSTON TX
77033-1919
US

IV. Provider business mailing address

6917 MARTIN LUTHER KING BLVD
HOUSTON TX
77033-1919
US

V. Phone/Fax

Practice location:
  • Phone: 713-987-9000
  • Fax: 713-987-9011
Mailing address:
  • Phone: 713-987-9000
  • Fax: 713-987-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number120309
License Number StateTX

VIII. Authorized Official

Name: MRS. CHIKENYEM NDDY OKOLIE
Title or Position: ADMINISTRATION
Credential: RN
Phone: 713-987-9000