Provider Demographics
NPI:1952394090
Name:ELITE SUPPORT CARE, INC.
Entity type:Organization
Organization Name:ELITE SUPPORT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-266-9057
Mailing Address - Street 1:10300 SW 72ND ST STE 182
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3002
Mailing Address - Country:US
Mailing Address - Phone:786-266-9057
Mailing Address - Fax:786-515-9688
Practice Address - Street 1:10300 SW 72ND ST STE 182
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3002
Practice Address - Country:US
Practice Address - Phone:786-266-9057
Practice Address - Fax:786-515-9688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 253Z00000X, 251E00000X
FL0499593517345376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002175300Medicaid
FL683629104Medicaid
FL683629103Medicaid
FL683629105Medicaid
FL683629198Medicaid
FL683619196Medicaid
FL683629104Medicaid