Healthcare Provider Details

I. General information

NPI: 1376489195
Provider Name (Legal Business Name): ELDERGRACE INC RETIREMENT PLAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 HOLLYWOOD BLVD STE 103
HOLLYWOOD FL
33021-6795
US

IV. Provider business mailing address

3911 HOLLYWOOD BLVD STE 103
HOLLYWOOD FL
33021-6795
US

V. Phone/Fax

Practice location:
  • Phone: 954-281-8221
  • Fax:
Mailing address:
  • Phone: 954-281-8221
  • Fax: 954-678-9766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SAUDIA SITAL
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 786-547-0051