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General NPI Number Information
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NPI Number | 1760162481
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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 | 07/18/2023
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Last Update Date | 07/18/2023
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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 | 818-429-6550
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Fax |
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Provider Business Mailing Address
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Address Line | 3826 S 65TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85043-0133
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Country | US
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Telephone | 174-735-6155
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DANIEL MOITALEL MUNKA
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Credential | DIRECTOR
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Telephone | 818-429-6550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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