Healthcare Provider Details

I. General information

NPI: 1023862125
Provider Name (Legal Business Name): LIFE OF PURPOSE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 N 22ND ST
TAMPA FL
33605-2762
US

IV. Provider business mailing address

2929 RAMBLER IVY LOOP
BRANDON FL
33510-2674
US

V. Phone/Fax

Practice location:
  • Phone: 813-563-8665
  • Fax:
Mailing address:
  • Phone: 813-563-8665
  • 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 Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: TAWANNA TAYLOR
Title or Position: CEO/ OWNER
Credential:
Phone: 813-563-8665