Healthcare Provider Details

I. General information

NPI: 1720982903
Provider Name (Legal Business Name): MOMBOSPICE CARE CUISINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W CENTRAL AVE
WINTER HAVEN FL
33880-6313
US

IV. Provider business mailing address

5209 SNOWY HERON DR
LAKELAND FL
33812-6317
US

V. Phone/Fax

Practice location:
  • Phone: 727-454-4011
  • Fax:
Mailing address:
  • Phone: 863-529-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL

VIII. Authorized Official

Name: HOPE BERRIEN
Title or Position: OWNER
Credential:
Phone: 863-529-1866