MEDICARE: ELITE BEG LIMITED LIABILITY CO

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	:	1891265997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE BEG LIMITED LIABILITY CO

Provider Business Mailing Address
First Line	:	209 S STEPHANIE ST # B177
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-5501
Country	:	US
Telephone Number	:	702-296-3654
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 S STEPHANIE ST # B177
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-5501
Country	:	US
Telephone Number	:	702-296-3654
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JASMINE LIMA DELCHAMBRE
Credential	:	MANAGING MEMBER
Telephone Number	:	702-296-3654

Provider Enumeration Date	:	11/30/2018
Last Update Date	:	11/30/2018

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