MEDICARE: ELITE TREATMENT CENTER

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	2083T0002X	Medical Toxicology (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1205441474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE TREATMENT CENTER

Provider Business Mailing Address
First Line	:	395 W LINCOLN HWY
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-2442
Country	:	US
Telephone Number	:	708-755-5117
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 W LINCOLN HWY
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-2442
Country	:	US
Telephone Number	:	708-755-5117
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. ALBERT ELLIS
Credential	:	CADC
Telephone Number	:	708-755-5117

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	09/14/2020

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