Healthcare Provider Details

I. General information

NPI: 1164933727
Provider Name (Legal Business Name): ELITE CHOICE COMPANION CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2017
Last Update Date: 10/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 SAN JUAN CIR
MELBOURNE FL
32935-5453
US

IV. Provider business mailing address

173 SAN JUAN CIR
MELBOURNE FL
32935-5453
US

V. Phone/Fax

Practice location:
  • Phone: 321-216-5562
  • Fax:
Mailing address:
  • Phone: 321-216-5562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number235037
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number235037
License Number StateFL

VIII. Authorized Official

Name: ANGELA SHACKELFORD
Title or Position: ADMINISTRATOR
Credential:
Phone: 321-216-5562