Provider Demographics
NPI:1366034423
Name:PROVIDENCE TRINITYCARE HOSPICE
Entity Type:Organization
Organization Name:PROVIDENCE TRINITYCARE HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY FOR ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-525-5392
Mailing Address - Street 1:5315 TORRANCE BLVD STE B1
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4011
Mailing Address - Country:US
Mailing Address - Phone:310-543-3400
Mailing Address - Fax:310-543-3437
Practice Address - Street 1:5315 TORRANCE BLVD STE B1
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4011
Practice Address - Country:US
Practice Address - Phone:310-543-3400
Practice Address - Fax:310-543-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty