Provider Demographics
NPI:1538857933
Name:ELOHIM PALLIATIVE CARE INC
Entity type:Organization
Organization Name:ELOHIM PALLIATIVE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TENEKA
Authorized Official - Middle Name:ROSHELL
Authorized Official - Last Name:GLASCO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:321-458-0404
Mailing Address - Street 1:747 VENUS DR
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-5370
Mailing Address - Country:US
Mailing Address - Phone:321-458-0404
Mailing Address - Fax:
Practice Address - Street 1:747 VENUS DR
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-5370
Practice Address - Country:US
Practice Address - Phone:321-458-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient