Healthcare Provider Details

I. General information

NPI: 1851914493
Provider Name (Legal Business Name): SHELIA L. SIMMONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 02/28/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 AZALEA TRL
HAVANA FL
32333-5135
US

IV. Provider business mailing address

67 AZALEA TRL
HAVANA FL
32333-5135
US

V. Phone/Fax

Practice location:
  • Phone: 850-212-5612
  • Fax:
Mailing address:
  • Phone: 850-212-5612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SHELIA L SIMMONS
Title or Position: OWNER
Credential:
Phone: 850-212-5612