=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396613881
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRIFECTA HOME HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2025
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2603 BLOCK DR
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32304-2548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-728-8284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2603 BLOCK DR
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32304-2548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-728-8284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | JULIAN KERR
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 850-728-8284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------