Provider Demographics
NPI:1528417060
Name:ELITE AMBULANCE LLC
Entity type:Organization
Organization Name:ELITE AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:HENDERLIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-656-4477
Mailing Address - Street 1:PO BOX 1597
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-1597
Mailing Address - Country:US
Mailing Address - Phone:615-656-4477
Mailing Address - Fax:615-656-4471
Practice Address - Street 1:228 W MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2681
Practice Address - Country:US
Practice Address - Phone:615-656-4777
Practice Address - Fax:615-656-4471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport