Provider Demographics
NPI:1972902302
Name:TRIPLE-E HEALTH SERVICES LLC
Entity type:Organization
Organization Name:TRIPLE-E HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:813-446-7249
Mailing Address - Street 1:11814 N 56TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1698
Mailing Address - Country:US
Mailing Address - Phone:813-642-9000
Mailing Address - Fax:813-642-9001
Practice Address - Street 1:11814 N 56TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1698
Practice Address - Country:US
Practice Address - Phone:813-642-9000
Practice Address - Fax:813-642-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993849251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109785Medicare UPIN