Healthcare Provider Details

I. General information

NPI: 1578292629
Provider Name (Legal Business Name): NEW FOUNDATION HOMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 OLD SOUTH DR
LAKELAND FL
33811-2311
US

IV. Provider business mailing address

1022 OLD SOUTH DR
LAKELAND FL
33811-2311
US

V. Phone/Fax

Practice location:
  • Phone: 863-419-6468
  • Fax:
Mailing address:
  • Phone: 863-419-6468
  • Fax:

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TALINA COX
Title or Position: CEO
Credential:
Phone: 863-419-6468