MEDICARE: SHIRLEY'S COMASSIONATE CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	343900000X	Non-emergency Medical Transport (VAN)
2	385H00000X	Respite Care
3	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
4	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1568260420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIRLEY'S COMASSIONATE CARE LLC

Provider Business Mailing Address
First Line	:	413 JUNE AVE
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-7211
Country	:	US
Telephone Number	:	407-947-1704
Fax Number	:	407-947-1704

Provider Business Practice Location Address
First Line	:	65 3RD ST NW STE 203
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4638
Country	:	US
Telephone Number	:	407-947-1704
Fax Number	:	407-947-1704

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	JALISA ANN BOYD
Credential	:
Telephone Number	:	407-947-1704

Provider Enumeration Date	:	03/06/2025
Last Update Date	:	05/19/2025

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