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General NPI Number Information
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NPI Number | 1023797420
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Entity Type | Organization
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Legal Business Name | ELITE INTEGRATED HEALTH LLC
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Dates
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Enumeration Date | 07/13/2023
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 432 GANTTOWN RD STE 103
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City | SEWELL
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State | NJ
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Zip | 08080-1895
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Country | US
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Telephone | 856-965-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 521 SICKLERVILLE RD STE 3
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-2636
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Country | US
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Telephone | 856-956-1000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAFIA NICOLA GROOMS
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Credential | DNP
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Telephone | 856-956-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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