Healthcare Provider Details

I. General information

NPI: 1841819489
Provider Name (Legal Business Name): TRI-LYFE SUPPORT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 E FERN ST APT 4
TAMPA FL
33610-1609
US

IV. Provider business mailing address

PO BOX 311356
TAMPA FL
33680-3356
US

V. Phone/Fax

Practice location:
  • Phone: 813-770-0202
  • Fax: 800-900-6377
Mailing address:
  • Phone: 813-770-0202
  • Fax: 800-900-6377

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: VALERIE JONES
Title or Position: ADMINISTRATOR
Credential:
Phone: 813-770-0202