=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740771336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIA'S HOME CARE #3, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2018
-----------------------------------------------------
Last Update Date | 05/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4229 SW 157TH CT
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33185-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-480-6014
-----------------------------------------------------
Fax | 305-266-1302
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4229 SW 157TH CT
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33185-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-480-6014
-----------------------------------------------------
Fax | 305-266-1302
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOSE MANUEL PEREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-287-2382
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 9859
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------