Healthcare Provider Details

I. General information

NPI: 1811734429
Provider Name (Legal Business Name): ELITE CARE HOME HEALTH AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10948 N 56TH ST STE 203
TEMPLE TERRACE FL
33617-3001
US

IV. Provider business mailing address

10948 N 56TH ST STE 203
TEMPLE TERRACE FL
33617-3001
US

V. Phone/Fax

Practice location:
  • Phone: 407-969-1595
  • Fax:
Mailing address:
  • Phone: 407-969-1595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARIE AUGUSTE
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-205-1989