Provider Demographics
NPI:1013181205
Name:TRIDIA HOSPICE CARE, LLC
Entity Type:Organization
Organization Name:TRIDIA HOSPICE CARE, LLC
Other - Org Name:TRIDIA HOSPICE & PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-554-6619
Mailing Address - Street 1:110 POLARIS PKWY STE 302
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7054
Mailing Address - Country:US
Mailing Address - Phone:614-473-0044
Mailing Address - Fax:
Practice Address - Street 1:110 POLARIS PKWY STE 302
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082
Practice Address - Country:US
Practice Address - Phone:614-473-0044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0154HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2952309Medicaid
OH361646Medicare Oscar/Certification