Provider Demographics
NPI:1518418516
Name:AHCMO 1 LLC
Entity Type:Organization
Organization Name:AHCMO 1 LLC
Other - Org Name:TRINA HEALTH OF MISSOURI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:POUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-307-3401
Mailing Address - Street 1:1585 WOODLAKE DR
Mailing Address - Street 2:104
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5740
Mailing Address - Country:US
Mailing Address - Phone:707-307-3401
Mailing Address - Fax:
Practice Address - Street 1:1585 WOODLAKE DR
Practice Address - Street 2:104
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5740
Practice Address - Country:US
Practice Address - Phone:707-330-7340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QI0500X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy