Organization
K ELITE TRANSPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATARI FENISE JACKSON (OWNER)
(312) 918-3786
Entity
Organization
Contact information
Practice address
17114 MAGNOLIA DR, HAZEL CREST, IL 60429-1023
(312) 918-3786
Mailing address
8612 S SAGINAW AVE, CHICAGO, IL 60617-2422
(708) 765-2475
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144809203
—
IL
Enumeration date
09/28/2021
Last updated
11/13/2021
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