Healthcare Provider Details

I. General information

NPI: 1023945037
Provider Name (Legal Business Name): CONTESSA KELLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 NW 2ND ST
WEBSTER FL
33597
US

IV. Provider business mailing address

1326 W NORTH BLVD STE 6
LEESBURG FL
34748-3997
US

V. Phone/Fax

Practice location:
  • Phone: 352-638-8433
  • Fax:
Mailing address:
  • Phone: 352-638-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CONTESSA KELLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 352-638-8433