Provider Demographics
NPI:1760431381
Name:TRINITY CARE & SUPPORT SERVICES,LLC
Entity Type:Organization
Organization Name:TRINITY CARE & SUPPORT SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHEREEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIGHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-595-6277
Mailing Address - Street 1:4921 PALMETTO DR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-7168
Mailing Address - Country:US
Mailing Address - Phone:772-595-6277
Mailing Address - Fax:772-595-8886
Practice Address - Street 1:4921 PALMETTO DR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-7168
Practice Address - Country:US
Practice Address - Phone:772-595-6277
Practice Address - Fax:772-595-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherCORP ID #