Healthcare Provider Details

I. General information

NPI: 1578403473
Provider Name (Legal Business Name): TRUSTED LIVING SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 NW 34TH CT
LAUDERDALE LAKES FL
33309-5534
US

IV. Provider business mailing address

3201 NW 34TH CT
LAUDERDALE LAKES FL
33309-5534
US

V. Phone/Fax

Practice location:
  • Phone: 954-812-9053
  • Fax:
Mailing address:
  • Phone: 954-812-9053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JHON-HYMMNOS FABIEN
Title or Position: OWNER
Credential:
Phone: 954-812-9053