Healthcare Provider Details

I. General information

NPI: 1063964906
Provider Name (Legal Business Name): FLOURISH IN PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 WOODCOCK RD STE 276
ORLANDO FL
32803-3514
US

IV. Provider business mailing address

1080 WOODCOCK RD STE 276
ORLANDO FL
32803-3514
US

V. Phone/Fax

Practice location:
  • Phone: 407-845-9797
  • Fax: 321-400-1233
Mailing address:
  • Phone: 407-845-9797
  • Fax: 321-400-1233

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 Number234579
License Number StateFL

VIII. Authorized Official

Name: MR. ROBERT KIMBARK LEE
Title or Position: PRESIDENT
Credential:
Phone: 407-845-9797