Provider Demographics
NPI:1083279269
Name:SPIRIT SOUL & BODY HOME CARE LLC
Entity Type:Organization
Organization Name:SPIRIT SOUL & BODY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATESA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-704-3336
Mailing Address - Street 1:4086 CANARY PALM CIR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-8310
Mailing Address - Country:US
Mailing Address - Phone:813-704-3336
Mailing Address - Fax:
Practice Address - Street 1:4086 CANARY PALM CIR
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-8310
Practice Address - Country:US
Practice Address - Phone:813-704-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care