Provider Demographics
NPI:1407553472
Name:ELITE MEDICAL PREP ACADEMY
Entity Type:Organization
Organization Name:ELITE MEDICAL PREP ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-994-8574
Mailing Address - Street 1:3609 SW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5104
Mailing Address - Country:US
Mailing Address - Phone:239-994-8574
Mailing Address - Fax:
Practice Address - Street 1:3609 SW 12TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-5104
Practice Address - Country:US
Practice Address - Phone:239-994-8574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:L22000206405
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care