Healthcare Provider Details

I. General information

NPI: 1992005698
Provider Name (Legal Business Name): TRINITY OMNISCIENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 33RD AVE
VERO BEACH FL
32967-1229
US

IV. Provider business mailing address

4825 33RD AVENUE
VERO BEACH FL
32967
US

V. Phone/Fax

Practice location:
  • Phone: 772-646-1430
  • Fax: 772-429-8163
Mailing address:
  • Phone: 772-646-1430
  • Fax: 772-429-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number002106300
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: PADRICA DAVIS
Title or Position: DIRECTOR
Credential:
Phone: 772-646-1430