Healthcare Provider Details

I. General information

NPI: 1043188360
Provider Name (Legal Business Name): ISAIAH VILLAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12137 WILD ACRES RD
LARGO FL
33773-2840
US

IV. Provider business mailing address

12137 WILD ACRES RD
LARGO FL
33773-2840
US

V. Phone/Fax

Practice location:
  • Phone: 727-224-1624
  • 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
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: LAVINA WARD
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 727-224-1624