Provider Demographics
NPI:1619578192
Name:ELSYOFF CARE CENTER LLC
Entity Type:Organization
Organization Name:ELSYOFF CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAILIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-312-8316
Mailing Address - Street 1:1727 NW 19TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-4915
Mailing Address - Country:US
Mailing Address - Phone:239-312-8316
Mailing Address - Fax:239-312-8320
Practice Address - Street 1:1727 NW 19TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-4915
Practice Address - Country:US
Practice Address - Phone:239-312-8316
Practice Address - Fax:239-312-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNAMedicaid