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General NPI Number Information
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NPI Number | 1992005698
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Entity Type | Organization
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Legal Business Name | TRINITY OMNISCIENT CARE
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Dates
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Enumeration Date | 10/27/2010
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 4825 33RD AVE
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City | VERO BEACH
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State | FL
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Zip | 32967-1229
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Country | US
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Telephone | 772-646-1430
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Fax | 772-429-8163
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Provider Business Mailing Address
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Address Line | 4825 33RD AVENUE
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City | VERO BEACH
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State | FL
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Zip | 32967
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Country | US
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Telephone | 772-646-1430
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Fax | 772-429-8163
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Authorized Official
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Title or Position | DIRECTOR
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Name | PADRICA DAVIS
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Credential |
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Telephone | 772-646-1430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 002106300
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License Number State | FL
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