Provider Demographics
NPI:1902276090
Name:ELEGANTE SERVICES INC.
Entity Type:Organization
Organization Name:ELEGANTE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-492-7680
Mailing Address - Street 1:1804 RANDALL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-3618
Mailing Address - Country:US
Mailing Address - Phone:718-492-7680
Mailing Address - Fax:347-507-5540
Practice Address - Street 1:1804 RANDALL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-3618
Practice Address - Country:US
Practice Address - Phone:718-492-7680
Practice Address - Fax:347-507-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB90713343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03720330Medicaid