Healthcare Provider Details

I. General information

NPI: 1255112884
Provider Name (Legal Business Name): TRINITY COMPASSIONATE CARE COMPANION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 SW PINCKNEY ST
MADISON FL
32340-2453
US

IV. Provider business mailing address

320 NE JAY ST
MADISON FL
32340-7127
US

V. Phone/Fax

Practice location:
  • Phone: 850-869-0246
  • Fax:
Mailing address:
  • Phone: 850-869-0246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

Name: MRS. MARY ELLEN SOLOMON-WARE
Title or Position: OWNER
Credential:
Phone: 850-869-0246