Provider Demographics
NPI:1437572104
Name:TECTRUST INCORPORATED
Entity Type:Organization
Organization Name:TECTRUST INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERLANTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-823-2139
Mailing Address - Street 1:434 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2804
Mailing Address - Country:US
Mailing Address - Phone:727-823-2139
Mailing Address - Fax:
Practice Address - Street 1:434 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2804
Practice Address - Country:US
Practice Address - Phone:727-823-2139
Practice Address - Fax:727-823-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL93104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140061400Medicaid