=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679388623
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELARA ME PCS 1, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2025
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 311 DARLING AVE, STE A-16
-----------------------------------------------------
City | SOUTH PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-703-2413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3010 LYNDON B JOHNSON FWY STE 1100
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-2712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-768-4373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COMPLIANCE PRIVACY & SAFETY OFFICER
-----------------------------------------------------
Name | KATIE MONASTIERE
-----------------------------------------------------
Credential | CHC
-----------------------------------------------------
Telephone | 517-768-4373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------