Healthcare Provider Details

I. General information

NPI: 1194580613
Provider Name (Legal Business Name): INFINITE HEART SUPPORT CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9340 N 56TH ST STE 200B
TEMPLE TERRACE FL
33617-5537
US

IV. Provider business mailing address

13923 PAINTED BUNTING LN
RIVERVIEW FL
33579-3525
US

V. Phone/Fax

Practice location:
  • Phone: 813-304-8251
  • Fax:
Mailing address:
  • Phone: 813-304-8251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: KELLIE JACKSON
Title or Position: OWNER/PROVIDER
Credential:
Phone: 813-304-8251