Provider Demographics
NPI:1851837413
Name:HOLLY TRINITY HOSPICE, INC.
Entity Type:Organization
Organization Name:HOLLY TRINITY HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EVGENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAILY
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:818-502-0724
Mailing Address - Street 1:1101 E BROADWAY
Mailing Address - Street 2:108
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 E BROADWAY
Practice Address - Street 2:108
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205
Practice Address - Country:US
Practice Address - Phone:818-502-0724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based