MEDICARE: ELITE SUPPORT CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	04995935517345	FL
3	251E00000X	Home Health Agency	0499593517345	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1067201	OTHER	FL	R.M.A

General Provider Information

NPI Number	:	1265579270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE SUPPORT CARE, INC.

Provider Business Mailing Address
First Line	:	10180 SW 28TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-2956
Country	:	US
Telephone Number	:	786-266-9057
Fax Number	:	786-515-9688

Provider Business Practice Location Address
First Line	:	10300 SW 72ND ST STE 182
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3002
Country	:	US
Telephone Number	:	786-266-9057
Fax Number	:	786-515-9688

Authorized Official
Title or Position	:	CEO
Name	:	MRS. LETICIA SANCHEZ JR.
Credential	:
Telephone Number	:	786-266-9057

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	01/03/2023

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