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General NPI Number Information
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NPI Number | 1164807004
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Entity Type | Organization
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Legal Business Name | ELITE CARE PLUS,LLC
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 319 ELDRIDGE AVENUE
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City | ORANGE PARK
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State | FL
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Zip | 32073
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Country | US
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Telephone | 904-541-4613
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Fax | 904-541-4624
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Provider Business Mailing Address
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Address Line | 319 ELDRIDGE AVENUE
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City | ORANGE PARK
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State | FL
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Zip | 32073
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Country | US
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Telephone | 904-541-4613
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Fax | 904-541-4624
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | SYED S HUSSAIN
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Credential | MD
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Telephone | 904-541-4613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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