Provider Demographics
NPI:1952843682
Name:ELENA'S HOME CORP
Entity Type:Organization
Organization Name:ELENA'S HOME CORP
Other - Org Name:ELENA'S HOME CORP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNERN
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-597-3812
Mailing Address - Street 1:4680 SW 154TH PLACE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185
Mailing Address - Country:US
Mailing Address - Phone:305-603-9169
Mailing Address - Fax:305-603-9169
Practice Address - Street 1:4680 SW 154TH PLACE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185
Practice Address - Country:US
Practice Address - Phone:305-603-9169
Practice Address - Fax:305-603-9169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-11
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12877310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility