Provider Demographics
NPI:1871200881
Name:ELITE LOGISTICS NORTHERN CALIFORNIA LLC
Entity type:Organization
Organization Name:ELITE LOGISTICS NORTHERN CALIFORNIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-834-9755
Mailing Address - Street 1:1273 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-3046
Mailing Address - Country:US
Mailing Address - Phone:239-834-9766
Mailing Address - Fax:
Practice Address - Street 1:1273 20TH ST
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-3046
Practice Address - Country:US
Practice Address - Phone:239-834-9766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle