Elite Health Plan, Inc.

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

Legal business name

ELITE HEALTH PLAN, INC.

Practice address

1131 W 6TH St Ste 255
Ontario, CA 91762-1117

Phone

(909) 630-2031

NPI assigned

Nov 7, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Gail Marie Blacklock, CHC

Title

Chief Compliance Officer

Phone

(909) 630-2031

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1053134098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1131 W 6TH ST STE 255",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917621117",
            "telephone_number": "909-630-2031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1131 W 6TH ST STE 255",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917621117",
            "telephone_number": "909-630-2031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE HEALTH PLAN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-07",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "BLACKLOCK",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "909-630-2031",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CHC"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Maintenance Organization in Ontario, CA
• Providers in Ontario, CA by specialty
• Health Maintenance Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.