Healthcare Provider Details

I. General information

NPI: 1154257152
Provider Name (Legal Business Name): HOUSE 3730 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 SKYVIEW DR
LAKELAND FL
33801-6946
US

IV. Provider business mailing address

2302 N CRYSTAL LAKE DR # 33801
LAKELAND FL
33801-6527
US

V. Phone/Fax

Practice location:
  • Phone: 863-934-9433
  • Fax:
Mailing address:
  • Phone:
  • 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

VIII. Authorized Official

Name: SHANTAVIA SHANICE TAYLOR
Title or Position: OWNER
Credential:
Phone: 863-934-9433