Healthcare Provider Details

I. General information

NPI: 1891338364
Provider Name (Legal Business Name): ELITE CHAMPIONS ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3106 DEERHOLLOW DR
MESQUITE TX
75181-3664
US

IV. Provider business mailing address

3106 DEERHOLLOW DR
MESQUITE TX
75181-3664
US

V. Phone/Fax

Practice location:
  • Phone: 469-693-2878
  • Fax:
Mailing address:
  • Phone: 469-693-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DORENE OSHOWOLE
Title or Position: OWNER/OPERATIONS MANAGER
Credential:
Phone: 469-693-2878