Healthcare Provider Details

I. General information

NPI: 1568260420
Provider Name (Legal Business Name): SHIRLEY'S COMASSIONATE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 3RD ST NW STE 203
WINTER HAVEN FL
33881-4638
US

IV. Provider business mailing address

413 JUNE AVE
HAINES CITY FL
33844-7211
US

V. Phone/Fax

Practice location:
  • Phone: 407-947-1704
  • Fax: 407-947-1704
Mailing address:
  • Phone: 407-947-1704
  • Fax: 407-947-1704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: JALISA ANN BOYD
Title or Position: OWNER/OPERATOR
Credential:
Phone: 407-947-1704