Provider Demographics
NPI:1063198166
Name:ELITE SENIOR SUPPLIES LLC
Entity type:Organization
Organization Name:ELITE SENIOR SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OVAIS
Authorized Official - Middle Name:ILYAS
Authorized Official - Last Name:MIANNOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-647-0118
Mailing Address - Street 1:1320 SE FEDERAL HWY STE 206
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3410
Mailing Address - Country:US
Mailing Address - Phone:877-381-9343
Mailing Address - Fax:
Practice Address - Street 1:1320 SE FEDERAL HWY STE 206
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3410
Practice Address - Country:US
Practice Address - Phone:877-381-9343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies