MEDICARE: ELITE PATIENT CARE LLC

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	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1356925499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE PATIENT CARE LLC

Provider Business Mailing Address
First Line	:	6732 DOGWOOD DR
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-4849
Country	:	US
Telephone Number	:	305-497-2101
Fax Number	:

Provider Business Practice Location Address
First Line	:	6732 DOGWOOD DR
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-4849
Country	:	US
Telephone Number	:	305-497-2101
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TYNYSHA SHARESE HOUSTON
Credential	:	RN
Telephone Number	:	305-497-2101

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	05/06/2021

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