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General NPI Number Information
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NPI Number | 1265065304
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Entity Type | Organization
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Legal Business Name | EKKLESIA COMMERCIAL SERVICES, LLC
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 119 S PALMETTO AVE STE 210
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4327
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Country | US
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Telephone | 386-400-5665
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 BEVILLE RD STE 606-154
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-5646
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Country | US
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Telephone | 386-527-9074
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GREG ROMEO
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Credential |
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Telephone | 386-527-9074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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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 | 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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Taxonomy #3
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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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