Healthcare Provider Details

I. General information

NPI: 1922939834
Provider Name (Legal Business Name): SELVANTA CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 MELISSA MILE RD 11-202
WINTER HAVEN FL
33884
US

IV. Provider business mailing address

1317 MELISSA MILE RD 11-202
WINTER HAVEN FL
33884
US

V. Phone/Fax

Practice location:
  • Phone: 863-259-6981
  • Fax:
Mailing address:
  • Phone: 863-259-6981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: KENNETHIA JOHNSON
Title or Position: OWNER
Credential:
Phone: 863-259-6981