Provider Demographics
NPI:1265065304
Name:EKKLESIA COMMERCIAL SERVICES, LLC
Entity type:Organization
Organization Name:EKKLESIA COMMERCIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-527-9074
Mailing Address - Street 1:1500 BEVILLE RD STE 606-154
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5646
Mailing Address - Country:US
Mailing Address - Phone:386-527-9074
Mailing Address - Fax:
Practice Address - Street 1:119 S PALMETTO AVE STE 210
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4327
Practice Address - Country:US
Practice Address - Phone:386-400-5665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104882300Medicaid