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General NPI Number Information
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NPI Number | 1164799904
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY LIFE CARE, INC
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 1631 ROCK SPRINGS RD STE 259
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City | APOPKA
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State | FL
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Zip | 32712-2229
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Country | US
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Telephone | 954-893-9499
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Fax | 954-893-9455
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Provider Business Mailing Address
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Address Line | 1631 ROCK SPRINGS RD STE 259
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City | APOPKA
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State | FL
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Zip | 32712-2229
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Country | US
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Telephone | 954-893-9499
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Fax | 954-893-9455
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Authorized Official
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Title or Position | MANAGING EMPLOYEE
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Name | OMAR ALLEN
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Credential |
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Telephone | 954-893-9499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 232379
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License Number State | FL
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