Provider Demographics
NPI:1144228560
Name:TRINITY REHAB LLC
Entity Type:Organization
Organization Name:TRINITY REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VARMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMASUNDARAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-592-9898
Mailing Address - Street 1:10224 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-8375
Mailing Address - Country:US
Mailing Address - Phone:352-592-9898
Mailing Address - Fax:352-592-9808
Practice Address - Street 1:10224 YALE AVE
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34613-8375
Practice Address - Country:US
Practice Address - Phone:325-592-9898
Practice Address - Fax:352-592-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-10
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684878Medicare ID - Type UnspecifiedCORF