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General NPI Number Information
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NPI Number | 1104470749
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Entity Type | Organization
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Legal Business Name | ELITE HOME CARE OF JAX LLC
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Dates
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Enumeration Date | 07/31/2019
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Last Update Date | 01/02/2021
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Provider Practice Location Address
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Address Line | 16334 DAWNWOOD CT
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City | JACKSONVILLE
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State | FL
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Zip | 32218-0107
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Country | US
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Telephone | 904-339-2611
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Fax |
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Provider Business Mailing Address
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Address Line | 16334 DAWNWOOD CT
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City | JACKSONVILLE
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State | FL
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Zip | 32218-0107
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Country | US
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Telephone | 904-339-2611
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | SHAWNDREA THOMAS-GIBSON
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Credential |
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Telephone | 904-339-2611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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