Healthcare Provider Details

I. General information

NPI: 1831918069
Provider Name (Legal Business Name): TRIDENT HEALTH CARE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 US HIGHWAY 27 UNIT 137642
CLERMONT FL
34713-4107
US

IV. Provider business mailing address

PO BOX 137642
CLERMONT FL
34713-7642
US

V. Phone/Fax

Practice location:
  • Phone: 539-235-6684
  • Fax:
Mailing address:
  • Phone: 313-926-9747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: LAKEYAH MONIQUE STARKS
Title or Position: CARGIVER
Credential: CNA/MA
Phone: 313-929-9747