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General NPI Number Information
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NPI Number | 1285029553
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Entity Type | Organization
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Legal Business Name | ELS
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 12403 OAK CEDAR PL SUITE 101
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City | TAMPA
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State | FL
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Zip | 33612-4332
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Country | US
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Telephone | 813-528-7213
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Fax |
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Provider Business Mailing Address
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Address Line | 12403 OAK CEDAR PL SUITE 101
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City | TAMPA
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State | FL
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Zip | 33612-4332
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Country | US
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Telephone | 813-528-7213
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GEORGINA PENA
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Credential |
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Telephone | 813-528-7213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 233889
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License Number State | FL
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