Healthcare Provider Details

I. General information

NPI: 1598653636
Provider Name (Legal Business Name): ELITE LINK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11506 ENCHANTED WOODS WAY
FREDERICKSBURG VA
22407-8608
US

IV. Provider business mailing address

11506 ENCHANTED WOODS WAY
FREDERICKSBURG VA
22407-8608
US

V. Phone/Fax

Practice location:
  • Phone: 571-315-4104
  • Fax:
Mailing address:
  • Phone: 703-342-6848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: RICHARD KEVIN MULHERN
Title or Position: OWNER
Credential:
Phone: 703-342-6848