MEDICARE: TRIPLEHEARTS HOME CARE,LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1124890090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIPLEHEARTS HOME CARE,LLC

Provider Business Mailing Address
First Line	:	1081 CROCUS ST NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-3296
Country	:	US
Telephone Number	:	404-402-3139
Fax Number	:

Provider Business Practice Location Address
First Line	:	1081 CROCUS ST NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-3296
Country	:	US
Telephone Number	:	404-402-3139
Fax Number	:

Authorized Official
Title or Position	:	LEGAL OFFICER
Name	:	MRS. THERESA CRESSIDA ROMANS-MCKENZIE
Credential	:	CNA
Telephone Number	:	404-402-3139

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	02/15/2024

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