Healthcare Provider Details

I. General information

NPI: 1083882872
Provider Name (Legal Business Name): TRC CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 PARK DR
FORT LAUDERDALE FL
33312-7341
US

IV. Provider business mailing address

1151 PARK DR
FORT LAUDERDALE FL
33312-7341
US

V. Phone/Fax

Practice location:
  • Phone: 954-793-3379
  • Fax: 954-530-6179
Mailing address:
  • Phone: 954-793-3379
  • Fax: 954-530-6179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number06000097
License Number StateFL

VIII. Authorized Official

Name: MS. TASHANNA CALDWELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-793-3379