Provider Demographics
NPI:1588615215
Name:TRINITY HOSPICE- CASTLE PEAK, LP
Entity Type:Organization
Organization Name:TRINITY HOSPICE- CASTLE PEAK, LP
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:SUTIE 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 1:6850 MANHATTAN BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-1227
Practice Address - Country:US
Practice Address - Phone:817-457-4329
Practice Address - Fax:972-386-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009074251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451794Medicare ID - Type UnspecifiedMEDICARE PROV NUMBER