Healthcare Provider Details

I. General information

NPI: 1285578138
Provider Name (Legal Business Name): MAY FOREST HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 W 13TH ST
LAKELAND FL
33805-2605
US

IV. Provider business mailing address

1021 W 13TH ST
LAKELAND FL
33805-2605
US

V. Phone/Fax

Practice location:
  • Phone: 863-393-6310
  • Fax:
Mailing address:
  • Phone: 863-393-6310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: SHIETH D EVANS
Title or Position: PRESIDENT
Credential:
Phone: 863-393-6310