Healthcare Provider Details

I. General information

NPI: 1295309722
Provider Name (Legal Business Name): TRINITY HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 LIPSCOMB ST NE
PALM BAY FL
32905-2940
US

IV. Provider business mailing address

4630 LIPSCOMB ST NE
PALM BAY FL
32905-2940
US

V. Phone/Fax

Practice location:
  • Phone: 321-327-5020
  • Fax:
Mailing address:
  • Phone: 321-327-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: ROSE ELIPHAR
Title or Position: OWNER
Credential:
Phone: 321-327-5020