Provider Demographics
NPI:1376873737
Name:TRINITAS ELDERCARE SPECIALTY SERVICES, PC
Entity Type:Organization
Organization Name:TRINITAS ELDERCARE SPECIALTY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-888-8988
Mailing Address - Street 1:PO BOX 3363
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98807-3363
Mailing Address - Country:US
Mailing Address - Phone:509-888-8988
Mailing Address - Fax:509-664-5056
Practice Address - Street 1:1505 N MILLER ST STE 230
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1597
Practice Address - Country:US
Practice Address - Phone:509-888-8988
Practice Address - Fax:509-664-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038313208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty