MEDICARE: ELITE HEALTH SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1093537300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	2355 HIGHWAY 36 W STE 400
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55113-3905
Country	:	US
Telephone Number	:	612-363-2105
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 HIGHWAY 36 W STE 400
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55113-3905
Country	:	US
Telephone Number	:	612-363-2105
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABDIRIZAQ ABDIRAHMAN FARAH
Credential	:
Telephone Number	:	612-363-2105

Provider Enumeration Date	:	10/28/2024
Last Update Date	:	10/28/2024

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Directions to “ELITE HEALTH SERVICES LLC ” Practice Location

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