Provider Demographics
NPI: | 1518167337 |
---|---|
Name: | PENNSYLVANIA TRINITY HOSPICE, LLC |
Entity Type: | Organization |
Organization Name: | PENNSYLVANIA TRINITY HOSPICE, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | BILLING MANAGER |
Authorized Official - Prefix: | MISS |
Authorized Official - First Name: | AMY |
Authorized Official - Middle Name: | MARIE |
Authorized Official - Last Name: | GLASSCOCK |
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: | 214-306-4520 |
Mailing Address - Fax: | 214-432-9220 |
Practice Address - Street 1: | 1255 DRUMMERS LN |
Practice Address - Street 2: | SUITE 100 |
Practice Address - City: | WAYNE |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19087-1565 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-293-7413 |
Practice Address - Fax: | 610-293-7459 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-07-19 |
Last Update Date: | 2007-07-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | 251G00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251G00000X | Agencies | Hospice Care, Community Based |