Healthcare Provider Details

I. General information

NPI: 1619383015
Provider Name (Legal Business Name): ELINA COLON-PENA CARE MANGER SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6722 GRAND BAHAMA DR
TAMPA FL
33615-5800
US

IV. Provider business mailing address

5700 MEMORIAL HWY STE 212D
TAMPA FL
33615-5258
US

V. Phone/Fax

Practice location:
  • Phone: 813-846-5252
  • Fax:
Mailing address:
  • Phone: 813-846-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ELIANA COLON-PENA
Title or Position: OWNER
Credential:
Phone: 813-846-5252