Provider Demographics
NPI:1356686166
Name:TRINITY PACIFIC 5, LLC
Entity type:Organization
Organization Name:TRINITY PACIFIC 5, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO / PARTNER / ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELWEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-295-9711
Mailing Address - Street 1:740 4TH ST N # 240
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2322
Mailing Address - Country:US
Mailing Address - Phone:727-295-9711
Mailing Address - Fax:727-815-8040
Practice Address - Street 1:28051 US HIGHWAY 19 N STE 107
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2642
Practice Address - Country:US
Practice Address - Phone:727-295-9711
Practice Address - Fax:727-815-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992887251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health