MEDICARE: ELITE HEALTHCARE SERVICES

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1144813775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 2651
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70571-2651
Country	:	US
Telephone Number	:	337-384-9219
Fax Number	:	337-376-2992

Provider Business Practice Location Address
First Line	:	811 ALBERTSON PKWY
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-5256
Country	:	US
Telephone Number	:	337-384-9219
Fax Number	:	337-376-2992

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	SHAWANNA GUILLORY
Credential	:	FNP-BC
Telephone Number	:	337-384-9219

Provider Enumeration Date	:	02/15/2021
Last Update Date	:	02/16/2021

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Directions to “ELITE HEALTHCARE SERVICES ” Practice Location

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