Healthcare Provider Details

I. General information

NPI: 1023428141
Provider Name (Legal Business Name): TRINITY NATIONAL HEALTHCARE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BUCK ISLAND RD
BLUFFTON SC
29910-5935
US

IV. Provider business mailing address

PO BOX 784
BLUFFTON SC
29910-0784
US

V. Phone/Fax

Practice location:
  • Phone: 843-815-7200
  • Fax: 843-815-7209
Mailing address:
  • Phone: 843-815-7200
  • Fax: 843-815-7209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care 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: MR. KURTIS JACKSON
Title or Position: CHIEF EXECUTIVE ADMINISTRATOR
Credential: LPN
Phone: 843-815-7200