NPIMap

Organization Active NPI

Elite Home Care of Jax LLC

  • Home Health Agency
  • Jacksonville, FL
National Provider Identifier
1104470749
Registry record updated Jan 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
ELITE HOME CARE OF JAX LLC
Practice address
16334 Dawnwood CT
Jacksonville, FL 32218-0107
Phone
(904) 339-2611
NPI assigned
Jul 31, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shawndrea Thomas-Gibson
Title
Ceo/Owner
Phone
(904) 339-2611

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Case Management Agency 251B00000X
Developmentally Disabled Services Day Training Agency 251C00000X
Home Health Agency 251E00000X Primary
In Home Supportive Care Agency 253Z00000X
Developmental Disabilities Clinic/Center 261QD1600X
Adult Care Home Facility 311ZA0620X
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X
Respite Care 385H00000X

Addresses

Primary practice location

16334 Dawnwood CT
Jacksonville, FL 32218-0107

Mailing address

16334 Dawnwood CT
Jacksonville, FL 32218-0107
Phone (904) 339-2611

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609545600000",
    "number": "1104470749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16334 DAWNWOOD CT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322180107",
            "telephone_number": "904-339-2611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16334 DAWNWOOD CT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322180107",
            "telephone_number": "904-339-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE HOME CARE OF JAX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-31",
        "last_updated": "2021-01-02",
        "certification_date": "2021-01-02",
        "status": "A",
        "authorized_official_last_name": "THOMAS-GIBSON",
        "authorized_official_first_name": "SHAWNDREA",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "904-339-2611"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.