Provider Demographics
NPI:1063686822
Name:ELITE SUPPORT CARE
Entity Type:Organization
Organization Name:ELITE SUPPORT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-266-9057
Mailing Address - Street 1:10180 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2956
Mailing Address - Country:US
Mailing Address - Phone:786-266-9057
Mailing Address - Fax:
Practice Address - Street 1:10300 SW 72ND ST STE 182
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3002
Practice Address - Country:US
Practice Address - Phone:786-266-9057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0499593517345251E00000X, 251J00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL683629196Medicaid
FL683629198Medicaid
FL1067201Medicaid
FL683629103Medicaid
FL683629105Medicaid
FL229699Medicaid
FL683629104Medicaid