Healthcare Provider Details

I. General information

NPI: 1104722479
Provider Name (Legal Business Name): CHOSEN HEARTS CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2026
Last Update Date: 10/14/2026
Certification Date: 10/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12808 BELVEDERE SONG WAY
RIVERVIEW FL
33578-7527
US

IV. Provider business mailing address

12808 BELVEDERE SONG WAY
RIVERVIEW FL
33578-7527
US

V. Phone/Fax

Practice location:
  • Phone: 813-690-9639
  • Fax:
Mailing address:
  • Phone: 813-690-9639
  • 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

VIII. Authorized Official

Name: KALYN THOMAS
Title or Position: OWNER
Credential:
Phone: 813-309-8739