Provider Demographics
NPI:1053096677
Name:ELITE GROUP HEALTH SERVICES LLC
Entity type:Organization
Organization Name:ELITE GROUP HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MABOH
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHIRI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:413-543-6820
Mailing Address - Street 1:37 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-6419
Mailing Address - Country:US
Mailing Address - Phone:413-543-6820
Mailing Address - Fax:
Practice Address - Street 1:950 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3064
Practice Address - Country:US
Practice Address - Phone:413-543-6820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty