Provider Demographics
NPI:1982000386
Name:TRIVIUM SOUTH HEALTHCARE, LLC
Entity Type:Organization
Organization Name:TRIVIUM SOUTH HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NIGEL
Authorized Official - Middle Name:ONIKO
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:877-541-5595
Mailing Address - Street 1:4055 LAWRENCEVILLE HWY NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2806
Mailing Address - Country:US
Mailing Address - Phone:877-541-5595
Mailing Address - Fax:770-717-0311
Practice Address - Street 1:4055 LAWRENCEVILLE HWY NW
Practice Address - Street 2:SUITE 200
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2806
Practice Address - Country:US
Practice Address - Phone:877-541-5595
Practice Address - Fax:770-717-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health