1851 Elkcam Boulevard Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1125096 Issued in FL

Legal business name

1851 ELKCAM BOULEVARD OPERATIONS LLC

Doing business as

Deltona Health Care

Practice address

1851 Elkcam Blvd
Deltona, FL 32725-3922

Phone

(386) 789-3769

Fax

(386) 789-6232

NPI assigned

Dec 22, 2011

Last updated

Nov 27, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kenneth Ussery

Title

VP

Phone

(407) 571-1550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Deltona Health Care Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1972872745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1851 ELKCAM BLVD",
            "city": "DELTONA",
            "state": "FL",
            "postal_code": "327253922",
            "telephone_number": "386-789-3769",
            "fax_number": "386-789-6232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1851 ELKCAM BLVD",
            "city": "DELTONA",
            "state": "FL",
            "postal_code": "327253922",
            "telephone_number": "386-789-3769",
            "fax_number": "386-789-6232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1851 ELKCAM BOULEVARD OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-22",
        "last_updated": "2023-11-27",
        "certification_date": "2020-04-27",
        "status": "A",
        "authorized_official_last_name": "USSERY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "407-571-1550"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1125096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00438600",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.5042",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "800 Concourse Pkwy S",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327516152",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Deltona Health Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Deltona Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 1234 Action Transportation Inc
• 4 Care Transportation
• 5Star General Mobility LLC
• A Healing Point Acupuncture Center, PLLC
• A Look Within Inc
• A New Beginning Therapy LLC

• Skilled Nursing Facility in Deltona, FL
• Providers in Deltona, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.