Healthcare Provider Details

I. General information

NPI: 1265137939
Provider Name (Legal Business Name): PURPOSE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 KAZAROS CIR
OCOEE FL
34761-3168
US

IV. Provider business mailing address

PO BOX 616220
ORLANDO FL
32861-6220
US

V. Phone/Fax

Practice location:
  • Phone: 727-743-7316
  • Fax:
Mailing address:
  • Phone: 352-462-8431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KOMEKO GAINES
Title or Position: OWNER/OPERATOR
Credential:
Phone: 727-743-7316