Provider Demographics
NPI:1346416815
Name:TRI CENTRAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:TRI CENTRAL HEALTHCARE, INC.
Other - Org Name:COSMOPOLITAN HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-888-3385
Mailing Address - Street 1:21860 BURBANK BLVD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6477
Mailing Address - Country:US
Mailing Address - Phone:818-888-3385
Mailing Address - Fax:818-888-3317
Practice Address - Street 1:21860 BURBANK BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6477
Practice Address - Country:US
Practice Address - Phone:818-888-3385
Practice Address - Fax:818-888-3317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000779251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA057470Medicare Oscar/Certification
IA057470Medicare Oscar/Certification