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General NPI Number Information
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NPI Number | 1053134098
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Entity Type | Organization
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Legal Business Name | ELITE HEALTH PLAN, INC.
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 1131 W 6TH ST STE 255
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City | ONTARIO
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State | CA
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Zip | 91762-1117
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Country | US
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Telephone | 909-630-2031
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Fax |
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Provider Business Mailing Address
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Address Line | 1131 W 6TH ST STE 255
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City | ONTARIO
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State | CA
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Zip | 91762-1117
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Country | US
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Telephone | 909-630-2031
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Fax |
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Authorized Official
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Title or Position | CHIEF COMPLIANCE OFFICER
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Name | MS. GAIL MARIE BLACKLOCK
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Credential | CHC
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Telephone | 909-630-2031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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