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General NPI Number Information
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NPI Number | 1497370092
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Entity Type | Organization
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Legal Business Name | ELITE TREATMENT CENTER, INC.
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 06/10/2020
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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 | 773-597-7698
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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 | 773-597-7698
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MISS CHRISTINE ELLIS
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Credential |
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Telephone | 708-781-3155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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