Provider Demographics
NPI:1043648728
Name:ELITE MANOR - KISSIMMEE
Entity type:Organization
Organization Name:ELITE MANOR - KISSIMMEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKHU-GAFOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-610-9621
Mailing Address - Street 1:4034 SUNNY DAY WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-9152
Mailing Address - Country:US
Mailing Address - Phone:646-610-9621
Mailing Address - Fax:407-286-6363
Practice Address - Street 1:4034 SUNNY DAY WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-9152
Practice Address - Country:US
Practice Address - Phone:646-610-9621
Practice Address - Fax:407-286-6363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12424310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility