Healthcare Provider Details

I. General information

NPI: 1750074910
Provider Name (Legal Business Name): HEART'S DESIRE HOMEMAKER & COMPANION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 3RD AVE N # 200B
SAINT PETERSBURG FL
33701-3899
US

IV. Provider business mailing address

333 3RD AVE N # 200B
SAINT PETERSBURG FL
33701-3899
US

V. Phone/Fax

Practice location:
  • Phone: 813-735-8065
  • Fax: 727-202-7331
Mailing address:
  • Phone: 813-735-8065
  • Fax: 727-202-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: ADREIKA V FLUELLEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 813-735-8065