Healthcare Provider Details

I. General information

NPI: 1912367913
Provider Name (Legal Business Name): HEART'S DESIRE HOMEMAKER & COMPANION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

333 3RD AVE N # 221
ST PETERSBURG FL
33701-3899
US

V. Phone/Fax

Practice location:
  • Phone: 866-735-8065
  • Fax: 727-202-7331
Mailing address:
  • Phone: 866-735-8065
  • Fax: 727-202-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 8
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: 866-735-8065