Provider Demographics
NPI:1215395785
Name:ELITE GARDEN
Entity Type:Organization
Organization Name:ELITE GARDEN
Other - Org Name:PALAMAR HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKH-GAFOOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-498-0998
Mailing Address - Street 1:4319 NEPTUNE ROAD
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769
Mailing Address - Country:US
Mailing Address - Phone:407-498-0998
Mailing Address - Fax:407-498-0988
Practice Address - Street 1:4319 NEPTUNE ROAD
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769
Practice Address - Country:US
Practice Address - Phone:407-498-0998
Practice Address - Fax:407-498-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12178310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility