MEDICARE: HEART ABLAZE CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	251S00000X	Community/Behavioral Health Agency
3	320800000X	Mental Illness Community Based Residential Treatment Facility
4	343900000X	Non-emergency Medical Transport (VAN)
5	376J00000X	Homemaker
6	372600000X	Adult Companion

General Provider Information

NPI Number	:	1043166762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART ABLAZE CARE LLC

Provider Business Mailing Address
First Line	:	1022 W NORTH BLVD
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-5057
Country	:	US
Telephone Number	:	877-225-2931
Fax Number	:

Provider Business Practice Location Address
First Line	:	1022 W NORTH BLVD
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-5057
Country	:	US
Telephone Number	:	877-225-2931
Fax Number	:

Authorized Official
Title or Position	:	AGENCY ADMINISTRATOR
Name	:	MRS. BIANCA PARKER
Credential	:
Telephone Number	:	352-455-1362

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “HEART ABLAZE CARE LLC ” Practice Location

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