# ELITE HOME CARE OF JAX LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104470749
- **Authorized official:** SHAWNDREA THOMAS-GIBSON (CEO/OWNER)
- **Authorized official phone:** (904) 339-2611

## Contact information

- **Practice address:** 16334 DAWNWOOD CT, JACKSONVILLE, FL 32218-0107
- **Practice address phone:** (904) 339-2611
- **Mailing address:** 16334 DAWNWOOD CT, JACKSONVILLE, FL 32218-0107
- **Mailing address phone:** (904) 339-2611

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | — |
| 171M00000X | Case Manager/Care Coordinator | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251C00000X | Developmentally Disabled Services Day Training Agency | — | NULL | — |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 261QD1600X | Developmental Disabilities Clinic/Center | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NULL | — |
| 385H00000X | Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 07/31/2019
- **Last updated:** 01/02/2021