Provider Demographics
NPI:1962816934
Name:TRIO HOSPICE - RURAL, INC
Entity Type:Organization
Organization Name:TRIO HOSPICE - RURAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAITHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JIFI BAHLOOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-779-5456
Mailing Address - Street 1:5920 SARATOGA BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4103
Mailing Address - Country:US
Mailing Address - Phone:361-779-5456
Mailing Address - Fax:361-991-0181
Practice Address - Street 1:304 E SAN PATRICIO AVE
Practice Address - Street 2:
Practice Address - City:MATHIS
Practice Address - State:TX
Practice Address - Zip Code:78368-2350
Practice Address - Country:US
Practice Address - Phone:361-779-5456
Practice Address - Fax:361-991-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care