Provider Demographics
NPI:1831918069
Name:TRIDENT HEALTH CARE GROUP
Entity type:Organization
Organization Name:TRIDENT HEALTH CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARGIVER
Authorized Official - Prefix:
Authorized Official - First Name:LAKEYAH
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:CNA/MA
Authorized Official - Phone:313-929-9747
Mailing Address - Street 1:PO BOX 137642
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34713-7642
Mailing Address - Country:US
Mailing Address - Phone:313-926-9747
Mailing Address - Fax:
Practice Address - Street 1:1100 US HIGHWAY 27 UNIT 137642
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34713-4107
Practice Address - Country:US
Practice Address - Phone:539-235-6684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No174200000XOther Service ProvidersMealsGroup - Single Specialty
No251G00000XAgenciesHospice Care, Community Based