Healthcare Provider Details

I. General information

NPI: 1063686822
Provider Name (Legal Business Name): ELITE SUPPORT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 72ND ST STE 182
MIAMI FL
33173-3002
US

IV. Provider business mailing address

10180 SW 28TH ST
MIAMI FL
33165-2956
US

V. Phone/Fax

Practice location:
  • Phone: 786-266-9057
  • Fax:
Mailing address:
  • Phone: 786-266-9057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0499593517345
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number0499593517345
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number0499593517345
License Number StateFL

VIII. Authorized Official

Name: LETICIA SANCHEZ
Title or Position: CEO
Credential:
Phone: 786-266-9057