Provider Demographics
NPI:1649648965
Name:TRINITY HOME SERVICE LLC
Entity type:Organization
Organization Name:TRINITY HOME SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:SHUMAKER
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-709-6569
Mailing Address - Street 1:2930 OAK TREE LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2655
Mailing Address - Country:US
Mailing Address - Phone:863-709-6569
Mailing Address - Fax:
Practice Address - Street 1:2930 OAK TREE LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2655
Practice Address - Country:US
Practice Address - Phone:863-709-6569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL010431700251E00000X
3747A0650X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No251E00000XAgenciesHome Health
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105452OtherCNA
FL102131600Medicaid
FL010431700Medicaid