Healthcare Provider Details

I. General information

NPI: 1770263386
Provider Name (Legal Business Name): SERVANT HEART LEADERSHIP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E COLONIAL DR STE 230
ORLANDO FL
32803-4734
US

IV. Provider business mailing address

11241 LORE WAY
ORLANDO FL
32832-6800
US

V. Phone/Fax

Practice location:
  • Phone: 407-257-8100
  • Fax:
Mailing address:
  • Phone: 407-257-8100
  • 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
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVIS TADEMY
Title or Position: PRESIDENT/CFO
Credential:
Phone: 407-257-8100