Healthcare Provider Details

I. General information

NPI: 1770096802
Provider Name (Legal Business Name): BEYOND TRUST HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2017
Last Update Date: 12/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 NORTHDALE BLVD STE 100E
TAMPA FL
33624-1862
US

IV. Provider business mailing address

16350 BRUCE B DOWNS BLVD STE 47142
TAMPA FL
33647-3207
US

V. Phone/Fax

Practice location:
  • Phone: 813-415-5221
  • Fax:
Mailing address:
  • Phone: 813-415-5221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LAKICCIA DUNNAGAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 813-415-5221