Provider Demographics
NPI:1912367913
Name:HEART'S DESIRE HOMEMAKER & COMPANION SERVICES, LLC
Entity Type:Organization
Organization Name:HEART'S DESIRE HOMEMAKER & COMPANION SERVICES, LLC
Other - Org Name:HEART'S DESIRE TRANSPORTATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADREIKA
Authorized Official - Middle Name:V
Authorized Official - Last Name:FLUELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-735-8065
Mailing Address - Street 1:333 3RD AVE N # 221
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3899
Mailing Address - Country:US
Mailing Address - Phone:866-735-8065
Mailing Address - Fax:727-202-7331
Practice Address - Street 1:333 3RD AVE N # 200B
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3899
Practice Address - Country:US
Practice Address - Phone:866-735-8065
Practice Address - Fax:727-202-7331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113410500Medicaid