Healthcare Provider Details

I. General information

NPI: 1912607144
Provider Name (Legal Business Name): TOTAL CARE GIVING HOME HEALTH AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 PETAL PAWPAW LN
SAINT CLOUD FL
34772-7081
US

IV. Provider business mailing address

4811 PETAL PAWPAW LN
SAINT CLOUD FL
34772-7081
US

V. Phone/Fax

Practice location:
  • Phone: 689-266-7227
  • 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 Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: JAZMIN WALLS
Title or Position: OWNER
Credential:
Phone: 689-266-7227