MEDICARE: TRINITY OMNISCIENT CARE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency		FL
2	251C00000X	Developmentally Disabled Services Day Training Agency	002106300	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992005698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY OMNISCIENT CARE

Provider Business Mailing Address
First Line	:	4825 33RD AVENUE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32967
Country	:	US
Telephone Number	:	772-646-1430
Fax Number	:	772-429-8163

Provider Business Practice Location Address
First Line	:	4825 33RD AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32967-1229
Country	:	US
Telephone Number	:	772-646-1430
Fax Number	:	772-429-8163

Authorized Official
Title or Position	:	DIRECTOR
Name	:	PADRICA DAVIS
Credential	:
Telephone Number	:	772-646-1430

Provider Enumeration Date	:	10/27/2010
Last Update Date	:	10/27/2010

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1861827966 — NICHOLAS T WOLTJEN PA-C
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1154066165 — SHERILYN RIVERA PA
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Directions to “TRINITY OMNISCIENT CARE ” Practice Location

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