Healthcare Provider Details

I. General information

NPI: 1972902302
Provider Name (Legal Business Name): TRIPLE-E HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11814 N 56TH ST SUITE A
TEMPLE TERRACE FL
33617-1698
US

IV. Provider business mailing address

11814 N 56TH ST SUITE A
TEMPLE TERRACE FL
33617-1698
US

V. Phone/Fax

Practice location:
  • Phone: 813-642-9000
  • Fax: 813-642-9001
Mailing address:
  • Phone: 813-642-9000
  • Fax: 813-642-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299993849
License Number StateFL

VIII. Authorized Official

Name: MR. JOSE PEREZ
Title or Position: CEO/CFO/ADMINISTRATOR
Credential: RN
Phone: 813-446-7249