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General NPI Number Information
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NPI Number | 1205441474
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Entity Type | Organization
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Legal Business Name | ELITE TREATMENT CENTER
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 395 W LINCOLN HWY
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-2442
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Country | US
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Telephone | 708-755-5117
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Fax |
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Provider Business Mailing Address
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Address Line | 395 W LINCOLN HWY
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-2442
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Country | US
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Telephone | 708-755-5117
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ALBERT ELLIS
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Credential | CADC
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Telephone | 708-755-5117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083T0002X
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Taxonomy Name | Medical Toxicology (Preventive Medicine) Physician
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License Number |
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License Number State |
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