Provider Demographics
NPI:1326498841
Name:ELITE MANOR KISSIMMEE LLC
Entity Type:Organization
Organization Name:ELITE MANOR KISSIMMEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ARJOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-483-7657
Mailing Address - Street 1:4034 SUNNY DAY WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-9152
Mailing Address - Country:US
Mailing Address - Phone:646-369-7917
Mailing Address - Fax:407-483-7657
Practice Address - Street 1:4034 SUNNY DAY WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-9152
Practice Address - Country:US
Practice Address - Phone:646-369-7917
Practice Address - Fax:407-483-7657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12424251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health