Provider Demographics
NPI:1396542353
Name:ELITE CARE WELLNESS LLC
Entity type:Organization
Organization Name:ELITE CARE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LILIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADHIAMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-356-1555
Mailing Address - Street 1:4040 E MCDOWELL RD STE 418
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4448
Mailing Address - Country:US
Mailing Address - Phone:602-550-9492
Mailing Address - Fax:
Practice Address - Street 1:4040 E MCDOWELL RD STE 418
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4448
Practice Address - Country:US
Practice Address - Phone:602-550-9492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service