Provider Demographics
NPI:1437100716
Name:TRINITY HOSPICE OF PHOENIX, LLC
Entity Type:Organization
Organization Name:TRINITY HOSPICE OF PHOENIX, LLC
Other - Org Name:TRINITY HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-306-4520
Mailing Address - Street 1:14180 DALLAS PKWY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-4341
Mailing Address - Country:US
Mailing Address - Phone:214-306-4500
Mailing Address - Fax:972-386-0704
Practice Address - Street 1:6245 N 24TH PKWY
Practice Address - Street 2:SUITE 200-A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-2024
Practice Address - Country:US
Practice Address - Phone:602-351-2233
Practice Address - Fax:972-386-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC0051251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ031527Medicare ID - Type UnspecifiedMEDICARE PROV NUMBER