Provider Demographics
NPI:1578344669
Name:1 T.R.U.S.T. LLC
Entity Type:Organization
Organization Name:1 T.R.U.S.T. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HERCULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-967-7078
Mailing Address - Street 1:17124 HEART OF PALMS DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3509
Mailing Address - Country:US
Mailing Address - Phone:407-967-7078
Mailing Address - Fax:813-936-6163
Practice Address - Street 1:17124 HEART OF PALMS DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3509
Practice Address - Country:US
Practice Address - Phone:407-967-7078
Practice Address - Fax:813-936-6163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health