Provider Demographics
NPI:1710347661
Name:TRINITY HEALTH LIFE PENNSYLVANIA, INC.
Entity Type:Organization
Organization Name:TRINITY HEALTH LIFE PENNSYLVANIA, INC.
Other - Org Name:MERCY LIFE - WEST PHILADELPHIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT STRATEGY AND GROWTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-669-3332
Mailing Address - Street 1:20255 VICTOR PKWY
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-7018
Mailing Address - Country:US
Mailing Address - Phone:734-343-0717
Mailing Address - Fax:248-347-5201
Practice Address - Street 1:4508 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3608
Practice Address - Country:US
Practice Address - Phone:215-573-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH LIFE PENNSYLVANIA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization