Provider Demographics
NPI:1780428359
Name:TRINITY GARDEN HOME CARE, LLC
Entity type:Organization
Organization Name:TRINITY GARDEN HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KENNESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-467-9393
Mailing Address - Street 1:PO BOX 89481
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33689-0408
Mailing Address - Country:US
Mailing Address - Phone:813-467-9393
Mailing Address - Fax:
Practice Address - Street 1:10522 WALKER VISTA DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3316
Practice Address - Country:US
Practice Address - Phone:813-467-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY GARDEN HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-19
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No372600000XNursing Service Related ProvidersAdult Companion
No385H00000XRespite Care FacilityRespite Care