Healthcare Provider Details

I. General information

NPI: 1083307706
Provider Name (Legal Business Name): TRIUNE HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 09/16/2023
Certification Date: 09/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 LANE AVE S STE 102
JACKSONVILLE FL
32210-2783
US

IV. Provider business mailing address

4275 HANGING MOSS DR
ORANGE PARK FL
32073-7643
US

V. Phone/Fax

Practice location:
  • Phone: 904-290-2939
  • Fax:
Mailing address:
  • Phone: 43-358-3139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: EMMANUEL RAMOS RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 904-335-8313