MEDICARE: TRINITY NATIONAL HEALTHCARE, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency
2	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1023428141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY NATIONAL HEALTHCARE, L.L.C.

Provider Business Mailing Address
First Line	:	PO BOX 784
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-0784
Country	:	US
Telephone Number	:	843-815-7200
Fax Number	:	843-815-7209

Provider Business Practice Location Address
First Line	:	333 BUCK ISLAND RD
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-5935
Country	:	US
Telephone Number	:	843-815-7200
Fax Number	:	843-815-7209

Authorized Official
Title or Position	:	CHIEF EXECUTIVE ADMINISTRATOR
Name	:	MR. KURTIS JACKSON
Credential	:	LPN
Telephone Number	:	843-815-7200

Provider Enumeration Date	:	04/28/2014
Last Update Date	:	04/28/2014

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