Healthcare Provider Details

I. General information

NPI: 1629994488
Provider Name (Legal Business Name): WOODBERRY CARES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 WOODBERRY CT
KISSIMMEE FL
34746-3050
US

IV. Provider business mailing address

19046 BRUCE B DOWNS BLVD STE B6
TAMPA FL
33647-2434
US

V. Phone/Fax

Practice location:
  • Phone: 407-201-2772
  • Fax:
Mailing address:
  • Phone: 813-317-8805
  • Fax: 813-317-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: KERINE BLACK
Title or Position: MANAGER
Credential:
Phone: 813-317-8805