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General NPI Number Information
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NPI Number | 1770263386
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Entity Type | Organization
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Legal Business Name | SERVANT HEART LEADERSHIP LLC
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 1510 E COLONIAL DR STE 230
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City | ORLANDO
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State | FL
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Zip | 32803-4734
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Country | US
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Telephone | 407-257-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 11241 LORE WAY
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City | ORLANDO
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State | FL
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Zip | 32832-6800
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Country | US
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Telephone | 407-257-8100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CFO
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Name | MR. DAVIS TADEMY
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Credential |
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Telephone | 407-257-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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