Provider Demographics
NPI:1366416364
Name:BLESSED TRINITY ELDER CARE CENTER
Entity type:Organization
Organization Name:BLESSED TRINITY ELDER CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HARDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-671-2823
Mailing Address - Street 1:5 SE 17TH ST
Mailing Address - Street 2:BUILDING L
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5152
Mailing Address - Country:US
Mailing Address - Phone:352-671-2823
Mailing Address - Fax:352-622-4849
Practice Address - Street 1:44 SW 15TH PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6531
Practice Address - Country:US
Practice Address - Phone:352-671-2823
Practice Address - Fax:352-622-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8971261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689770300Medicaid