Organization
ELITE DME
Active
Organization
ELITE DME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAFAEL JACKSON (OWNER)
(707) 720-7245
Entity
Organization
Contact information
Practice address
1375 BONITA BAHIA, BENICIA, CA 94510-2405
(925) 250-9601
Mailing address
1375 BONITA BAHIA, BENICIA, CA 94510-2405
(925) 250-9601
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Enumeration date
10/23/2024
Last updated
12/17/2024
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