Healthcare Provider Details

I. General information

NPI: 1376475491
Provider Name (Legal Business Name): PERSEVERANCE HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N FEDERAL HWY STE 150
FORT LAUDERDALE FL
33301-3507
US

IV. Provider business mailing address

100 N FEDERAL HWY STE 150
FORT LAUDERDALE FL
33301-3507
US

V. Phone/Fax

Practice location:
  • Phone: 772-200-3771
  • Fax: 772-302-3801
Mailing address:
  • Phone: 772-200-3771
  • Fax: 772-302-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHANTELL WALKINE
Title or Position: OWNER
Credential:
Phone: 772-200-3771