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General NPI Number Information
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NPI Number | 1396542353
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Entity Type | Organization
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Legal Business Name | ELITE CARE WELLNESS LLC
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 4040 E MCDOWELL RD STE 418
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City | PHOENIX
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State | AZ
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Zip | 85008-4448
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Country | US
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Telephone | 602-550-9492
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Fax |
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Provider Business Mailing Address
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Address Line | 4040 E MCDOWELL RD STE 418
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City | PHOENIX
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State | AZ
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Zip | 85008-4448
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Country | US
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Telephone | 602-550-9492
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LILIAN ADHIAMBO
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Credential |
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Telephone | 747-356-1555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community 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 | 261QH0100X
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Taxonomy Name | Health Service 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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