Healthcare Provider Details

I. General information

NPI: 1386351393
Provider Name (Legal Business Name): HOLY TRINITY CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4152 W BLUE HERON BLVD STE 126
RIVIERA BEACH FL
33404-4859
US

IV. Provider business mailing address

5598 PEBBLE BROOK LN
BOYNTON BEACH FL
33472-2401
US

V. Phone/Fax

Practice location:
  • Phone: 561-713-7173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER LED'S GISCARD JEROME
Title or Position: CMO
Credential: MD
Phone: 347-455-7845