MEDICARE: SELVANTA CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1922939834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELVANTA CARE LLC

Provider Business Mailing Address
First Line	:	1317 MELISSA MILE RD
Second Line	:	11-202
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884
Country	:	US
Telephone Number	:	863-259-6981
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 MELISSA MILE RD
Second Line	:	11-202
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884
Country	:	US
Telephone Number	:	863-259-6981
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KENNETHIA JOHNSON
Credential	:
Telephone Number	:	863-259-6981

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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