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General NPI Number Information
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NPI Number | 1386351393
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Entity Type | Organization
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Legal Business Name | HOLY TRINITY CENTERS LLC
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 4152 W BLUE HERON BLVD STE 126
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-4859
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Country | US
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Telephone | 561-713-7173
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Fax |
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Provider Business Mailing Address
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Address Line | 5598 PEBBLE BROOK LN
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City | BOYNTON BEACH
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State | FL
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Zip | 33472-2401
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CMO
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Name | CHRISTOPHER LED'S GISCARD JEROME
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Credential | MD
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Telephone | 347-455-7845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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