Provider Demographics
NPI:1912923608
Name:ELITE MOBILITY, INC.
Entity type:Organization
Organization Name:ELITE MOBILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANELLE
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-544-8380
Mailing Address - Street 1:400 12TH ST STE 14
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2410
Mailing Address - Country:US
Mailing Address - Phone:209-544-8380
Mailing Address - Fax:
Practice Address - Street 1:400 12TH ST STE 14
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2410
Practice Address - Country:US
Practice Address - Phone:209-544-8380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4965480001Medicare NSC