Provider Demographics
NPI:1164799904
Name:TRI-COUNTY LIFE CARE, INC
Entity Type:Organization
Organization Name:TRI-COUNTY LIFE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-893-9499
Mailing Address - Street 1:1631 ROCK SPRINGS RD
Mailing Address - Street 2:STE 259
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2229
Mailing Address - Country:US
Mailing Address - Phone:954-893-9499
Mailing Address - Fax:954-893-9455
Practice Address - Street 1:1631 ROCK SPRINGS RD
Practice Address - Street 2:STE 259
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2229
Practice Address - Country:US
Practice Address - Phone:954-893-9499
Practice Address - Fax:954-893-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232379251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health